Hepatitis B virus (HBV) continues to be a significant cause for post-transfusion hepatitis in India, in spite of the introduction of compulsory hepatitis B surface antigen (HBsAg) screening. To understand the true HBV-infective pool in the blood donor population, HBV DNA was detected by a 32P-labelled dot blot hybridisation assay in 605 donor units that were negative for HBsAg by a third-generation Elisa. Serum alanine aminotransferase (ALT) was estimated in all these samples and correlated with DNA positivity. The frequency of HBV DNA positivity in HBsAg-negative units was very high (9.91%) and correlated well with the elevation in ALT (p < 0.00005). However, the frequency of elevated ALT was high (11.9%), using the locally determined upper limit of normal, and half of the DNA-positive samples had a normal ALT. Thus, ALT is a poor surrogate marker for HBV infectivity and efforts should be made to apply DNA detection systems in blood banks.
A study was carried out on 1,028 voluntary blood donors to see how body mass index (BMI) correlated with the serum alanine amino transferase (ALT) activity. The mean ALT (U/l) values were 19.35, 27.63, 40.79 and 54.41 in the four BMI categories of < or = 20, 20.1-25, 25.1-30 and > 30, respectively. This study showed that the mean serum ALT level of obese subjects (BMI > 30 kg/m2), compared with the two categories of normal subjects (i.e. BMI < or = 20 and BMI = 20.1-25 kg/m2), was increased by 2.8 and 1.96 times, respectively. Compared with the BMI group < or = 20, there was a gradual per cent increase in the mean serum ALT in the three different BMI groups: 20.1-25 (+133%), 25.1-30 (+196%) and > 30 kg/m2 (+280%). This indicates the need to correct ALT values for BMI for blood donor screening, instead of using actual ALT values.
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