Risk Factors in Transmission of Non‐A, Non‐B Posttransfusion Hepatitis: The Role of Hepatitis B Antibody in Donor Blood

Abstract

Risk of developing icteric hepatitis in a transfusion study involving cardiac surgery patients was 0.2 per cent per unit of blood transfused with the ratio of icteric to anicteric cases being 1:4. Risk of developing hepatitis was proportional to the number of units transfused: one to four units, 4 per cent; six to ten units, 8 per cent; 11 to 20 units, 19 per cent; greater than 21 units, 42 per cent. The prevalence of type B hepatitis was low (6 per cent), with the vast majority of patients being shown to have non-A non-B hepatitis. However, a greater incidence of hepatitis type B serologic events was observed among recipients of anti-HBs positive blood than those transfused only with units not containing antibody (p = 0.04. A significantly greater incidence of non-A, non-B hepatitis was observed among patients transfused with blood containing anti-HBs when compared with a group who received blood without antibody (p less than 0.01). Caution should be exercised in interpretation of this difference because patients transfused with blood containing anti-HBs received significantly more units of blood. However, utilization of stepwise regression analysis to unconfound the two dependent variables suggest that the use of blood containing anti-HBs increases the hepatitis risk (p = 0.06) although the number of units transfused was the more significant factor (p less than 0.001). Additional data from carefully designed studies are needed to determine if donor blood containing anti-HBs significantly increases the risk of transmitting non-A, non-B hepatitis.

Current status of post‐transfusion hepatitis

“…However, if serial transaminase determinations are used at intervals after transfusion about a five-fold increase in detection of hepatitis can be anticipated The relationship of development of transaminase elevations to donor units transfused in the cardiac surgery study cited above was a 4% for 1-5 units, 8% for 6-10 units, 20% for 11-20 units, and 40% for more than 20 units. These data (42,47) are similar to that reported by other groups of investigators in this decade after routine testing of donors for HBsAg was initiated in blood banks (44). The anicteric cases of post-transfusion hepatitis cannot be disregarded as clinically unimportant because they may develop chronic hepatic disease and also represent a source of potential infection to persons with whom they have close personal contact (48).…”

Non-A, Non-B Hepatitis

“…Some investigators refer to peak levels of serum aminotransfera~es,~~,s~ others to elevation ranging between one and five times beyond the upper normal range.76*83 The majority would accept a level beyond two to two and a half times the upper normal range. 3,25,29,30,32,76,[84][85][86] Patients with chronic liver disease secondary to previously well-documented (such as the PTH variety) NANB hepatitis are said to have fewer clinical stigmas than those from other cause^.^,^^,^^ Serum IgM levels are not usually elevated above 300 mg/dl and IgG levels remain within the normal range.62 Autoantibodies to mitochondria or smooth muscle components are rarely p o s i t i~e .~~,~~,~~ Liver histologic features are not unique, although some distinctive patterns have been reported (see "Histologic Features" later).…”

“…This study also showed a correlation between the number of units given and subsequent risk from development of PTH, but on regression analysis the contributing anti-HBs positivity was still significant.3o Only 8 % of blood units were anti-HBs positive and therefore the finding that the presence of anti-HBs positivity among blood units also correlated with the number given was not surprising. 30 In an earlier similar studyZo8 involving 358 patients, there was no significant difference between the number of NANB PTH events in recipients of anti-HBs positive (13 of 169) and negative (8 of 189) donations, although in the latter study the confounding effect of numbers of blood units given was not separately a s s e s~e d .~~.~~~ The prevalence of anti-HBs positivity among volunteer blood donors has been estimated at between 0.28 and 14.4% in ~m e r i c a .~~~~~~~~~~~~~ Among commercial donors overall, this is higher (15.3 to 22.6%),60,208 in drug addicts, 52 to 70%,60,61 and in multiply transfused patients up to 8 2 . 6 V 0 .~~ Thus, the finding of excess anti-HBs positivity in commercial donors may include a subpopulation of drug addicts; the latter as donors in turn are known to be associated with increased risk of subsequent NANB PTH.~' Other studies have not found a significant correlation between anti-HBs positivity in donors and subsequent NANB PTH, but involved small numbers of patients.2o6…”

Posttransfusion Hepatitis in Japan

“…Most cases of posttransfusion hepatitis are now consid ered to be of the non-A, non-B variety [1,4,5], This form is thought to progress to a chronic condition [6][7][8][9], and the possibly gives rise to hepatocellular carcinoma [10,11], The risk factors of posttransfusion hepatitis have been investigated in regard to age and sex of recipients [6.12], serum alanine aminotransferase (ALT) [13], anti-HBc [14], anti-HBs [15] and guanase activity [16] of donated blood, and the volume of transfusion. To assess the risk of development of this disease.…”