Strategies for the prevention of post-transfusion hepatitis.

Hepatitis is a common and potentially serious adverse effect of blood transfusion. A large number of strategies have been developed or proposed to reduce the incidence of post-transfusion hepatitis (PTH). The education of physicians regarding the risks of hemotherapy and the judicious use of blood must be the cornerstone of any substantial reduction in PTH. The use of volunteer rather than paid donors is associated with a much reduced incidence of PTH. Deferral of donors implicated in PTH is also helpful. Other proposed strategies include donor alanine amino-transferase levels, donor anti-HBc testing, the provision of immune globulin to recipients, and the inactivation, removal, or immune neutralization of the virus from blood products. In the absence of a blood substitute, autologous transfusion is an excellent means of improving transfusion safety. The incidence of PTH type B should decrease as an increasing proportion of donors and recipients are immunized by vaccine and as increasingly sensitive tests for HBsAg become available. The development of a serologic test and vaccine for non-A, non-B hepatitis would be outstanding accomplishments, but their absence underscores the need to pursue vigorously other means of reducing the incidence of the disease.