Ismay S L, Thomas S, Fellows A, Keller A, Kenrick K G, Archer G T, Wylie B R, Cossart Y E
Australian Red Cross Society Blood Transfusion Service, Sydney, NSW.
Med J Aust. 1995 Jul 17;163(2):74-7. doi: 10.5694/j.1326-5377.1995.tb126118.x.
To evaluate the risk of post-transfusion and postoperative non-A non-B hepatitis in Australia immediately before the introduction of screening for hepatitis C.
Retrospective testing of blood samples from a prospective study of cardiac surgery patients. Samples were taken from transfusion recipients and non-transfused controls at regular intervals for 12 months after surgery during 1987-1989. For all donor, recipient and control samples, alanine aminotransferase (ALT) levels were measured and tests for antibody to hepatitis B (anti-HBc, anti-HBs) and, when available, to hepatitis C (anti-HCV) were performed.
Cardiac surgery units.
Participants were included if they lived in the metropolitan area, and had not had a transfusion in the past year.
Post-transfusion hepatitis (two consecutive samples showing raised ALT levels, > 90 IU/L with no other known cause); hepatitis C infection and carriage (antibody to hepatitis C).
Post-transfusion hepatitis occurred in 1.1% of 736 recipients of blood not screened for hepatitis C (i.e., two cases per 1000 unscreened units given). No hepatitis occurred in 514 controls. Seven of the eight patients with post-transfusion hepatitis seroconverted to hepatitis C virus infection. Seven of the 26 anti-HCV-positive donations transmitted hepatitis C, six of these were positive by recombinant immunoblot assay (RIBA) (one by second generation testing only) and one was RIBA indeterminate. Nineteen were RIBA non-reactive; one transmitted hepatitis but the recipient did not develop anti-HCV, although hepatitis C RNA was detected in the donation. Serum ALT was raised in four of the six infective donations.
Hepatitis C virus infection accounted for almost all cases of non-A non-B post-transfusion hepatitis. First generation anti-HCV tests detected about 85% of infective donations. Surrogate testing of donations by ALT or anti-HBc offers no additional advantage.
在澳大利亚引入丙型肝炎筛查之前，评估输血后和术后非甲非乙型肝炎的风险。
对心脏手术患者前瞻性研究中的血样进行回顾性检测。在1987年至1989年期间，术后12个月定期从输血受者和未输血对照中采集样本。对所有供体、受者和对照样本，测量丙氨酸转氨酶（ALT）水平，并检测乙肝抗体（抗-HBc、抗-HBs），如有条件，还检测丙肝抗体（抗-HCV）。
心脏外科病房。
居住在大都市地区且过去一年未输血的患者被纳入研究。
输血后肝炎（连续两份样本显示ALT水平升高，>90 IU/L且无其他已知原因）；丙型肝炎感染和携带（丙肝抗体）。
在736例未筛查丙肝的输血受者中，1.1%发生输血后肝炎（即每1000单位未筛查血液中有2例）。514例对照中未发生肝炎。8例输血后肝炎患者中有7例血清转化为丙型肝炎病毒感染。26份抗-HCV阳性献血中有7份传播了丙型肝炎，其中6份通过重组免疫印迹法（RIBA）检测为阳性（1份仅通过第二代检测为阳性），1份RIBA结果不确定。19份RIBA无反应；1份献血传播了肝炎，但受者未产生抗-HCV，尽管在该献血中检测到丙肝RNA。6份感染性献血中有4份血清ALT升高。
丙型肝炎病毒感染几乎占所有非甲非乙型输血后肝炎病例。第一代抗-HCV检测可检测出约85%的感染性献血。通过ALT或抗-HBc对献血进行替代检测没有额外优势。
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