Current risks of viral hepatitis from blood transfusions

Abstract

The incidence of transfusion-associated hepatitis in the United States has fallen dramatically since the late 1960s. Where once the risks were so great that as many as one in three transfused patients contracted hepatitis, now they are infinitesimal. Many factors share responsibility for this accomplishment; however, two stand above the rest: (i) improved donor selection and screening criteria, especially elimination of paid blood donations; and (ii) major advances in testing for viral hepatitis carriers. Currently, four tests are used for the prevention of transfusion-associated hepatitis: (i) hepatitis B surface antigen; (ii) hepatitis C virus antibody; (iii) hepatitis B core antibody; and (iv) alanine aminotransferase. The first two tests are largely responsible for the current low risks of transfusion-associated hepatitis due to hepatitis B virus and hepatitis C virus of 1 in 63,000 and 1 in 125,000, per unit, respectively. To further reduce the risks of transfusion-associated hepatitis will require the enhanced sensitivity provided by nucleic acid amplification techniques (e.g. polymerase chain reaction). Currently, however, no such tests are licensed and practical, automated, or inexpensive enough for individual blood donor screening. We have made such great strides in the prevention of transfusion-transmitted hepatitis that background rates of viral hepatitis now greatly exceed the risk of transmission via transfusion. For this reason, while it may still be reasonable to consider a transfusion as a possible cause for hepatitis, it is imperative that many other possibilities (e.g., iatrogenic and other risk factors) be ruled out.

Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients

“…Immunomodulation can also be considered as a potential pathophysiological explanation for the increased risk of harvest-site infection [42][43][44]. In addition, transfusion of red blood cells still carries the risks of acute infection with bacterial or viral agents [45,46], and an association with an increased risk for various postoperative infections has been described repeatedly [2,5,7,9,39,47]. However, due to the limited total number of patients, our study was unable to detect rare infectious as well as rare pulmonary adverse events.…”

Enhanced Surveillance of Acute Hepatitis B and C in Four Health Regions in Canada, 1998 TO 1999

“…For the analysis of potential risk facEnhanced surveillance of acute hepatitis B and C tors, a ranking of the known potential risk factors was determined based on currently available epidemiological information. This includes results from the Sentinel Health Unit Surveillance from 1993 to 1995 in Canada (Centre for Infectious Disease Prevention and Control, unpublished data), Centers for Disease Control and Prevention hepatitis surveillance report (14), and data in the epidemiological literature for hepatitis B (3,5,15) and hepatitis C (4,6,(16)(17)(18)(19), respectively. According to the ranking (see ordered lists of risk factors in the previous section), a case was assigned to a single risk factor category if the patient reported a history of such a risk factor in the six months before the onset of the disease, regardless of a history of other risk factors that were ranked lower than this risk factor in the ranking.…”

The cost of blood transfusions in cancer patients: a reanalysis of a Canadian economic evaluation

“…Since that time, the risk for hepatitis C has been reduced to one in 125,000 units, respectively. 15,16 In the case of HIV infection, a recent Canadian study reported that the risk of blood -transfusion -induced transmission has been reduced to one in 390,00 units. 17 Therefore, these decreased risks have eliminated the cost of infection as a component on the analysis.…”