Antibody to Hepatitis B Core Antigen as a Paradoxical Marker for Non-A, Non-B Hepatitis Agents in Donated Blood

Abstract

The relationship between the presence of antibody to hepatitis B core antigen (anti-HBc) in donor blood and the development of hepatitis in recipients of that blood was studied in 6293 blood donors and 481 recipients who were followed for 6 to 9 months after transfusion. Of 193 recipients of at least 1 unit of blood positive for anti-HBc, 23 (11.9%) developed non-A, non-B hepatitis compared with 12 (4.2%) of 288 recipients of only anti-HBc-negative blood (p less than 0.001). Donor anti-HBc status was not significantly associated with the development of hepatitis B in the recipient and was negatively associated with the development of cytomegalovirus hepatitis. The relationship of donor anti-HBc status and the development of non-A, non-B hepatitis in the recipient was independent of transfusion volume and elevated donor transaminase level. Although 88% of anti-HBc-positive blood units were not associated with recipient non-A, non-B hepatitis, calculation of maximal corrected efficacy predicted that exclusion of anti-HBc-positive donors might have prevented 43% of the cases of non-A, non-B hepatitis with a donor loss of 4%. Because of the serious chronic consequences of non-A, non-B hepatitis, surrogate tests for non-A, non-B virus carriers must be seriously considered.

Low-Positive Anti-Hepatitis C Virus Enzyme Immunoassay Results: An Important Predictor of Low Likelihood of Hepatitis C Infection

“…Before the advent of EIA tests for anti-HCV, surrogate markers such as ALT and anti-HBc were useful in identifying persons likely to transmit non-A, non-B hepatitis (21)(22)(23)(24). Our study confirms the utility of multiple ALT activity measurements in suggesting the presence or absence of HCV RNA.…”

“…The two most helpful markers were alanine aminotransferase (ALT) activity and antibody to the hepatitis B virus core antigen (antiHBc) (21)(22)(23)(24). Several studies have shown that there are differences in the frequency of increased ALT activity and positive anti-HBc between blood donors with low and high absorbance values for anti-HCV (4,9,14,17 ).…”

Italian blood donors with anti-HBc and occult hepatitis B virus infection

“…[26][27][28][29] A number of other studies showed cases of HBV transmission after the transfusion of anti-HBc-positive blood. [13][14][15][16] A recent study showed that up to 16% of anti-HBc/antiHBs-positive donors have circulating HBV-DNA unbound to anti-HBs in their sera and thus in a potentially infective form.…”

Infectious diseases and the anaesthetist

“…Surrogate testing of blood donors for Anti-HBc and serum ALT and the exclusion of blood which is positive, for either of these may reduce the incidence of NANBH by 40 per cent. 13 Chronic hepatitis is a frequent sequel of NANBH occurring after transfusion, with abnormal liver function tests persisting for more than a year in 10 to 60 per cent of patients. 3s…”