Evidence of hepatitis in patients receiving transfusions of blood components containing antibody to hepatitis C

Abstract

When hepatitis C virus antibody (anti-HCV) enzyme immunoassay (EIA1) testing became available in 1990, we tested samples from previously transfused blood units, traced the recipients of reactive units, and evaluated the recipients for HCV infection during the 12 months after transfusion. Ten of 42 recipients of EIA1-reactive blood were anti-HCV reactive on follow-up by EIA1 and 12 were reactive by a second- generation assay (EIA2). Reverse transcriptase-polymerase chain reaction (RT-PCR) detected HCV RNA in 5 seronegative recipients. In all, 17 of 42 recipients (40%) of EIA1-reactive blood had evidence of HCV infection. In comparison, 54 surgery patients, who received either no transfusion or autologous EIA1-nonreactive blood, remained EIA1 nonreactive and RT-PCR negative for 1 year; 1 patient (1.8%) became EIA2 reactive (P < or = .01). Of the recipients of anti-HVC reactive blood transfusions (reactive by both EIA1 and a supplemental 4-antigen strip immunoblot assay [RIBA2]), 14 (93%) of the recipients had evidence of HCV infection compared with only 3 of 27 recipients (11%) of EIA1-reactive, RIBA2-nonreactive blood (P < or = .01). Thus, blood components reactive for anti-HCV EIA1 may have transmitted HCV up to 40% of the time, but blood components found reactive by both EIA1 and RIBA2 may transmit HCV with a frequency of greater than 90%.

Risk of hepatitis C in patients who received blood from donors subsequently shown to be carriers of hepatitis C virus

“…In this study, all of the traceable recipients of blood positive by RIBA 2 or PCR were found to have been infected with HCV. This contrasts with earlier studies using the first generation EIA and less rigorous confirmation methods, in which 40-93?40 of recipients were shown to have seroconverted (van der Poel et al, 1990;Kolho et al, 1992;Aoki et al, 1993). Our results suggest that virtually all recipients of blood shown to be HCV-positive by currently available immunoblot and PCR techniques will have seroconverted.…”

Lookback on donors who are repeatedly reactiveon first‐generation hepatitis C virus assays:justification and rational implementation

“… recognition that HCV EIA 1.0 identified a high proportion of the infected donors giving blood after initiation of HCV screening; concern over the effectiveness of general HCV lookback; and the ethical principle that patients have the right to know of a specific infectious exposure, even though the probability that the donors were infected may have been as low as 25 percent 6–8 …”

Characteristics of hepatitis C‐positive blood donors in Victoria, Australia

“…Studies to date suggest that between 91 and 100% of transfusion recipients given blood collected from donors later found to be anti‐HCV positive will develop one or more markers for HCV ( Aoki et al ., 1993 ; Skaug et al ., 1993 ; Foberg et al ., 1996 ). However, caution should be exercised when comparing infectivity rates in these studies as variations may be due to differences in assay performance.…”