Hepatitis C Lookback Programme: a single hospital experience

Abstract

As part of the national Hepatitis C (HCV) Lookback Programme, HCV-infected donors donating blood after September 1991 were identified and the fate of their previous donations received at a single hospital were traced; 123 of 160 implicated blood components were traceable and transfused. Only 19 recipients were alive and traceable and were tested for HCV. Nine of the 14 recipients (64%) of HCV-positive donations and 2 of 5 recipients (40%) of HCV-indeterminate donations had evidence of HCV infection. Neither the number of donor exposures nor the type of component was predictive of recipient HCV status. Three recipients have chronic active hepatitis. The Hepatitis C Lookback Programme successfully identifies some but not all cases of transfusion-transmitted HCV. Transfusion records, particularly in the medical case notes, should be substantially improved. Many of the traced recipients are young, so that identification of HCV is of great importance.

Estimated progression rates in three United Kingdom hepatitis C cohorts differed according to method of recruitment

“…The only solution to this problem is to follow up individuals identified by screening to identify asymptomatic infections. This method of recruitment is similar to that used for the National Register lookback, and may explain the lower progression in this group, but is complicated by the high comorbidity in transfusion recipients and loss of patients prior to registration (mainly due to early mortality) [19].…”

“…Initially, the register contained transfusion recipients identified during the UK HCV lookback exercise, which began in early 1995 [19]. More recently, patients have also been recruited from the National Blood Service/Health Protection Agency infected donor surveillance scheme and from the British Paediatric Surveillance Unit's (BPSU) active surveillance of HCV.…”

Introduction of a Central Documentation of Blood Products according to §§ 14 and 17 Transfusionsgesetz (TFG) by a Computerized Blood Bank Data System

“…Previously published data from look-back procedures showed that it is often impossible to confirm that the patient had received the component. Information about transfusions performed was missing in hepatitis C look-back studies in 8.7% [3], 9% [4], 10% [5], and up to 16% [6] due to the untraceability of the blood product. The computerized documentation system used in our department before September 1999 documented only the patient and the ward where the blood products were delivered to.…”

The HCV National Register: towards informing the natural history of hepatitis C infection in the UK

“…We have attempted to collate a data set that is robust, reliable, and includes as many eligible transfusion recipients as possible. The process of the HCV lookback did not trace and test all recipients of potentially infected components [ 5]. Several factors, for example, younger age and certain specialties at the time of transfusion, have been shown to be positively associated with receiving testing.…”

“…1). The process by which patients were initially traced, tested and referred for specialist HCV‐care during the national lookback programme has been reported elsewhere [ 5]. The clinicians were asked to provide anonymised information on the patients’ clinical status, test results, treatment and management (Table 1) using a standard form.…”