Misleading hepatitis B testing in the setting of intravenous immunoglobulin

Abstract

Intravenous immunoglobulin (IVIG) is commonly used for a wide range of diagnoses, by multiple pediatric subspecialists. We report two cases of hepatitis B screening results post IVIG infusion, where positive anti-Hepatitis B core antigen serology tests indicated possible occult hepatitis infection, leading to a delay in care. However, serial antibody testing showed results consistent with the passive transfer of antibodies.

Case Report: Kidney Transplantation in a Patient With Acquired Agammaglobulinemia and SLE. Issues and Challenges

“…It is worth noting that the patient was a non-responder after the completion of HBV vaccination. Similar observations have already been reported in two pediatric patients (32) and in a Canadian cohort of 11 patients with ITP, 3 of whom had a seroconversion with positive anti-core IgG for HBV, post IVIG administration (32,33). Retesting in the following weeks, after pausing IVIG revealed a return to former status, concluding that the passive transfer of pre-formed immunoglobulins was the etiology of the case (33).…”

Hepatitis B Core Antibody: Role in Clinical Practice in 2020

“…Fortunately, since 2002, the best anti-HBc tests have a false positive rate of < 2/1000 even in low-risk individuals [4]. One potential scenario where the risk of false-positive testing may be increased is in the setting of intravenous immunoglobulin where passive antibody transfer may lead to false-positive testing before serial testing shows subsequent degradation of core antibodies [5]. To determine a patient's HBV status, HBsAg is always tested alongside anti-HBc and anti-HBs ( Fig.…”

Misleading Hepatitis B Serology Following Rho (D) Immune Globulin (Human) Injection and Influenza Vaccine

“…Ilboudo et al reported two cases of misleading hepatitis B results following IVIG administration in children. 1 One child who had Evans syndrome and systemic lupus erythematosus received IVIG in the form of Gamunex™. She received 3 doses of hepatitis B vaccination at birth.…”

“…Previous studies have highlighted some cases of misleading hepatitis B serology results which led to either unnecessary or delay in treatment. 1-4 Having a HBsAb titre of more than 10 mIU/mL after hepatitis B vaccination is generally considered to confer immunity to hepatitis B. 5 , 6 This case report describes a an unusual case of a patriuent who was immunised against hepatitis B, presenting with a transitory false positive HBcAb, possibly as a result of administration of either Rho (D) immune globulin (Human) injection or influenza vaccine.…”