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

Josep M. Barrera, MD; Miquel Bruguera, MD; M. Guadalupe Ercilla, MD; José M. Sánchez-Tapias, MD; María P. Gil, PhD; Cristina Gil, PhD; Josep Costa, PhD; Antonio Gelabert, MD; Joan Rodés, MD; and Ricardo Castillo, MD
[+] Article, Author, and Disclosure Information

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.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;115(8):596-600. doi:10.7326/0003-4819-115-8-596
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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.





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