Elevated Alanine Aminotransferase (Alt) in Blood Donors: An Assessment of the Main Associated Conditions and Its Relationship to the Development of Hepatitis C

Abstract

The determination of aminotranferases levels is very useful in the diagnosis of hepatopathies. In recent years, an elevated serum ALT level in blood donors has been associated with an increased risk of post-transfusion hepatitis (PTH). The purpose of the study was to research the factors associated with elevated ALT levels in a cohort of voluntary blood donors and to evaluate the relationship between increased ALT levels and the development of hepatitis C (HCV) infection. 166 volunteer blood donors with elevated ALT at the time of their first donation were studied. All of the donors were questioned about previous hepatopathies, exposure to hepatitis, exposure to chemicals, use of medication or drugs, sexual behaviour, contact with blood or secretions and their intake of alcohol. Every three months, the serum levels of AST, ALT, alkaline phosphatase, gamma glutamyl transpeptidase, cholesterol, triglyceride and glycemia are assessed over a two year follow-up. The serum thyroid hormone levels as well as the presence of auto-antibodies were also measured. Abdominal ultrasound was performed in all patients with persistently elevated ALT or AST levels. A needle biopsy of liver was performed in 9 donors without definite diagnostic after medical investigation. The presence of anti-HCV antibodies in 116 donors were assayed again the first clinical evaluation. At the end of follow-up period (2 years later) 71 donors were tested again for the presence of anti-HCV antibodies. None of donors resulted positive for hepatitis B or hepatitis C markers during the follow-up. Of the 116 donors, 101 (87%) had persistently elevated ALT serum levels during the follow-up. Obesity and alcoholism were the principal conditions related to elevated ALT serum levels in 91/101 (90.1%) donors. Hypertriglyceridemia, hypercholesterolemia, hypothyroidism and diabetes mellitus also were associated with increased ALT levels. Only 1/101 (0.9%) had mild chronic active non A-G viral hepatitis and 3/101 (2.9%) had liver biopsy with non-specific reactive hepatitis. The determination of ALT levels was not useful to detect donors infected with HCV at donation in Brazil, including the initial seronegative anti-HCV phase.

Prevalence of Occult Hepatitis C Virus Infection among Blood Donors in Jiangsu, China

“…In Brazil, 2 independent studies were presented with conflicting conclusions. Mangus et al [24] monitored 166 volunteer blood donors with elevated ALT and found that the ALT levels were not useful in detecting donors infected with HCV during blood donation. Gonçales et al [25] monitored 359 HBsAg- and anti-HCV-negative blood donors with elevated ALT levels.…”

Prevalence and factors of elevated alanine aminotransferase in central Taiwan – a retrospective study

“…In addition, our study showed that hypertriglyceridemia had an effect on elevated ALT. Goncales et al reported that hypertriglyceridemia and hypercholesterolemia were associated with elevated ALT [ 37 ]. But few reports have addressed the relationship between serum triglyceride level and ALT level [ 38 , 39 ].…”

A multi–Chinese blood center study testing serologic‐negative donor samples for hepatitis C virus and human immunodeficiency virus with nucleic acid testing

“…As a donor screening test, ALT has low specificity for detecting individuals with TTVI risk and is no longer used in routine donor screening in many countries. Because ALT elevation is not usually associated with HCV infection in the preseroconversion phase, it is likely that the abnormal ALT results for Samples 2 and 3 are unrelated to the HCV infection status of these donors 18‐20 …”