Incidence of Non-A, Non-B Hepatitis after Screening Blood Donors for Antibodies to Hepatitis C Virus and Surrogate Markers

  1. Josep M. Barrera, MD;
  2. Miquel Bruguera, MD;
  3. M. Guadalupe Ercilla, MD;
  4. José M. Sánchez-Tapias, MD;
  5. María P. Gil, PhD;
  6. Cristina Gil, PhD;
  7. Josep Costa, PhD;
  8. Antonio Gelabert, MD;
  9. Joan Rodés, MD; and
  10. Ricardo Castillo, MD

    Abstract

    ▪Objective: To compare the effect of screening blood donors for antibodies to hepatitis C virus (anti-HCV) on the incidence of non-A, non-B hepatitis in recipients with that of screening blood donors for antibodies to hepatitis B core antigen (anti-HBc) and elevated alanine aminotransferase levels.

    ▪Design: Cohort analysis of serum samples from donors and recipients. Recipients were followed for 12 months to determine the occurrence of non-A, non-B hepatitis.

    ▪Setting: The blood-transmitted viruses unit and the liver unit of a university teaching hospital.

    ▪Subjects: A total of 250 patients who had open heart surgery and their 3142 blood donors.

    ▪Measurements: Donor sera were tested for anti-HCV by enzyme-linked immunosorbent assay (ELISA) and, in the event of a positive result, by recombinant immunoblot assay (RIBA). Antibodies to anti-HBc and serum alanine aminotransferase (ALT) levels were also measured. Measurements of anti-HCV and ALT activity in recipients were done before transfusion and at regular intervals during follow-up.

    ▪Main Results: Of the 250 transfusion recipients, 40 developed non-A, non-B hepatitis. Of the 3142 donors, 70 were positive for anti-HCV by ELISA, 440 were positive for anti-HBc, and 177 had alanine aminotransferase levels between 0.67 and 1.33 µkat/L. The sensitivity (87%), specificity (89%), positive predictive value (59%), and negative predictive value (97%) of blood-donor screening were higher for anti-HCV than for anti-HBc (82%, 36%, 21%, and 91%, respectively) and for elevated alanine aminotransferase levels (65%, 70%, 29%, and 91%, respectively). The expected number of donors excluded because of the presence of anti-HCV was considerably smaller than that of donors with positive results for surrogate markers of hepatitis.

    ▪Conclusion: Screening blood donors for the presence of anti-HCV is more accurate than screening for surrogate markers (anti-HBc and ALT) and protects more effectively against post-transfusion non-A, non-B hepatitis.

    Article and Author Information

    • From the Hospital Clinic i Provincial, University of Barcelona, Barcelona, Spain. For current author addresses, see end of text.

    • Grant Support: In part by grants 88/1985 and 91/0360 from Fondo de Investigacion de la Seguridad Social of the Spanish Ministerio de Sanidad. Josep Costa is supported by the Fundació Catalana per l'Estudi del Fetge.

    • Requests for Reprints: Miquel Bruguera, MD, Liver Unit, Hospital Clinic i Provincial, Villarroel 170, 09036 Barcelona, Spain.

    • Current Author Addresses: Drs. Barrera, Gil, Gelabert, and Castillo:

      Blood Transmitted Viruses Unit, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain.

      Drs. Bruguera, Sánchez-Tapias, Costa, and Rodés: Liver Unit, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain.

      Dr. Ercilla: Immunology Service, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain.

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    1. Ann Intern Med October 15, 1991 vol. 115 no. 8 596-600
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