Non-A, Non-B Hepatitis After Intravenous Gammaglobulin

Webster, Alison; Lever, Andrew M. L.; Trépo, C; Hantz, Olivier; Vitvitski, L.; Ochs, HansD.; Fischer, Susanna; Virant, FrankS.; Lee, MartinL.; Mankarious, Samia; Kingdon, HenryS.; Wedgwood, RalphJ.

doi:10.1016/s0140-6736(86)90852-4

Cited by 27 publications

(11 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ALT levels in case 2 were less abnormal, sug gesting that the initial infection in this patient was less severe than in the others. This is consistent with the experi ence of others that the ensuing chronic NANBH is more severe in patients with immunodeficiency than in those without [8,14]. The presence of symptoms in two patients only (cases 1 and 2), and the lack of a clear relationship between the presence of symptoms and the abnormal levels of ALT reached, underlines the importance of surveillance of all patients by serum ALT assay, even if asymptomatic.…”

Section: Discussionsupporting

confidence: 91%

“…The presence of symptoms in two patients only (cases 1 and 2), and the lack of a clear relationship between the presence of symptoms and the abnormal levels of ALT reached, underlines the importance of surveillance of all patients by serum ALT assay, even if asymptomatic. The NANBH in 2 of the 3 immunodeficient cases has had a much less severe course than is the experience of others [8,14], with apparent spontaneous recovery in two cases. Those cases reported by Björkander et al [8] were treated with intramuscular IgG following the transmission of NANBH, and it is tempting to speculate that the less severe course in these cases may have been due in part to their continued therapy with IV IgG.…”

Section: Discussionmentioning

confidence: 75%

See 1 more Smart Citation

Transmission of Non-A, Non-B Hepatitis by pH4-Treated Intravenous Immunoglobulin

Williams¹,

Yap²,

Gillon³

et al. 1989

Vox Sanguinis

View full text Add to dashboard Cite

Four patients (2 with X-linked, one with common variable hypogammaglobulinaemia, and 1 with ulcerative colitis) developed non-A, non-B hepatitis (NANBH) following administration of a specific batch of intravenous immunoglobulin (IV IgG) manufactured by the Scottish National Blood Transfusion Service using the pH4/mild pepsin method. Each patient had normal serum ALT levels over a preceding period of 12-67 months, with raised values developing within 4-18 weeks of first administration of the implicated batch. Two patients had very mild symptoms of hepatitis, the other 2 being asymptomatic. Over a follow-up period of 8-12 months, ALT levels returned to normal in 3 patients, but biopsy-proven chronic NANBH developed in the fourth. The level of NANBH virus in the starting plasma used to manufacture this batch may have exceeded the capacity of the process to inactivate the virus. The transmission of NANBH by one of approximately 110 batches administered demonstrates the importance of continued close surveillance of recipients of IV IgG, even if asymptomatic, by regular monitoring of liver function tests and recording of all batches received.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 75%

Transmission of Non-A, Non-B Hepatitis by pH4-Treated Intravenous Immunoglobulin

Williams¹,

Yap²,

Gillon³

et al. 1989

Vox Sanguinis

View full text Add to dashboard Cite

show abstract

“…The patient had no other hepatotoxic factor, such as drugs, alcohol, iron overload through recurrent blood transfusion, autoimmunity, or concomitant infection with other viruses, which could have contributed to the liver damage caused by HCV infection. In light of the above, the occurrence of non-A, non-B hepatitis [2,15,18,19] or hepatitis C [3] in agammaglobulinaemic patients treated with intravenous immunoglobulin heightens our awareness of the potentially dangerous nature of this disease in association with an immune deficiency state. According to these reports, cirrhosis developed frequently within a relatively short period after the immunoglobulin transfusions.…”

Section: Discussionmentioning

confidence: 99%

Rapidly progressive hepatitis C in a patient with common variable immunodeficiency

et al. 1996

View full text Add to dashboard Cite

show abstract

“…In 1985 it became clear that the human immunodeficiency virus (HIV) could be transmitted by human coagulation factor concentrates and there was concern that HIV could also be transmitted by IVIG preparations. The possibility of transmission of a retrovirus was raised by Webster and Leaver [46], who reported that one of the 12 patients found to have HIV infection after receiving an experimental IVIG preparation in 1983 had also developed a progressive demyelinating disease of the spinal cord. As demyelination of the spinal cord has not been seen in more than 200 patients with XLA or CVI, the possibility that the experimental IVIG preparation also transmitted a retrovirus was raised [46].…”

Section: Other Viruses Transmitted By Immune Globulin Preparationsmentioning

confidence: 99%

“…The possibility of transmission of a retrovirus was raised by Webster and Leaver [46], who reported that one of the 12 patients found to have HIV infection after receiving an experimental IVIG preparation in 1983 had also developed a progressive demyelinating disease of the spinal cord. As demyelination of the spinal cord has not been seen in more than 200 patients with XLA or CVI, the possibility that the experimental IVIG preparation also transmitted a retrovirus was raised [46]. There was also concern in I 985, because at this time blood products were derived from the plasma of donors who were not screened for antibody to HIV.…”

Section: Other Viruses Transmitted By Immune Globulin Preparationsmentioning

confidence: 99%

The viral safety of intravenous immune globulin

Yap

1996

Clinical and Experimental Immunology

View full text Add to dashboard Cite

The viral safety of intravenous immune globulin (IVIG) preparations has been investigated since 1983 when it was discovered that non‐A, non‐B hepatitis (NANBH) could be transmitted by an experimental IVIG preparation. Recently, it has been demonstrated that the virus causing NANBH is the hepatitis C virus (HCV). A number of subsequent episodes of HCV transmission by IVIG have been reported, but not all the factors that have led to this transmission arc clearly understood. However, based on two episodes of HCV transmission by anti‐D immune globulin (formulated for intravenous administration), it appears that cold ethanol fractionation is important in ensuring viral safety because both of the implicated anti‐D immune globulin preparations were manufactured without cold ethanol fractionation. Other HCV transmission episodes have been associated with chromatography (particularly DEAE‐Sephadcx chromatography) as a separation step carried out to further purify IgG, after cold ethanol fractionation, and it is possible that such a procedure has only a marginal partitioning capacity for infective HCV virions. The role of anti‐HCV screening in improving the viral safety of IVIG preparations remains unclear, but a recent transmission episode by a previously safe IVIG preparation suggests that the absence of anti‐HCV antibodies during plasma fractionation may affect the partitioning characteristics of HCV and may also cause a loss of neutralizing antibody against HCV. All of the IVIG preparations associated with HCV transmission have been formulated as freeze‐dried preparations and this may have been important in stabilizing HCV during the period prior to administration to patients. No other viruses appear to have been transmitted by IVIG preparations, but prior to seroconversion, HCV‐infected plasma donors may continue to contaminate plasma pools used for the manufacture of blood products, despite anti‐HCV screening, and additional viral inactivation steps such as incubation at pH4 or solvent‐detergent treatment should be incorporated into the production process of all IVIG preparations.

show abstract

Non-A, Non-B Hepatitis After Intravenous Gammaglobulin

Cited by 27 publications

References 8 publications

Transmission of Non-A, Non-B Hepatitis by pH4-Treated Intravenous Immunoglobulin

Transmission of Non-A, Non-B Hepatitis by pH4-Treated Intravenous Immunoglobulin

Rapidly progressive hepatitis C in a patient with common variable immunodeficiency

The viral safety of intravenous immune globulin

Contact Info

Product

Resources

About