Moore S B, Kruger J R, Rakela J, Vamvakas E C, Schimek C, Germer J J, Persing D H
Mayo Clinic and Foundation, Rochester, Minnesota, USA.
Transfusion. 1995 Apr;35(4):308-12. doi: 10.1046/j.1537-2995.1995.35495216079.x.
Despite the introduction of surrogate testing and subsequent antibody testing of donor blood, transmission of hepatitis C virus (HCV) still occurs. The institution from which this report originates is a medical center, and many of the blood donors have also been seen as patients at the institution. This provided an opportunity for comparison of donor questionnaire responses and medical history information and for correlation of those findings with HCV test results.
HCV polymerase chain reaction (PCR) testing was performed on nine stored frozen sera from donors or former donors with previous positive results on HCV enzyme immunoassay (EIA) (first- or second-generation) and recombinant immunoblot assay (RIBA) (first- or second-generation). The medical histories were also reviewed for 22 of 23 such HCV EIA-repeatedly reactive, RIBA-positive donors and 88 randomly chosen HCV-negative donors. The lifestyle information was compared with the donors' responses on the blood donation questionnaires. The data were then correlated with available clinical and laboratory evidence of HCV transmission to transfusion recipients.
For eight donors, there were no recipients of their blood to be assessed. For 9 of the remaining 15 donors, there were recipients who were tested for HCV. Recipients of blood from 5 of these 9 donors were repeatedly reactive for HCV; while recipients of blood from 4 donors were not. Donor PCR positivity correlated with apparent transmission (p = 0.047). Twelve of 20 HCV EIA-positive donors for whom history and questionnaires were available for comparison had at least one suggestive lifestyle or established risk factor in their medical records, while none of 88 HCV-negative controls did (p < 0.0001). The data did not indicate that paid donation correlated with failure to disclose these factors.
Despite more explicit and intrusive donor questioning, it is still not possible to identify all possible risk factors at donations, though many donors who do not disclose all their risk factors are eliminated from the pool by the increasingly sensitive donor tests. As long as tests are not completely foolproof, workers must be vigilant regarding the ability to elicit complete information on a donor's risk. Further study is required to determine the best way(s) to do so.
尽管采用了替代检测以及随后的献血者血液抗体检测，但丙型肝炎病毒（HCV）仍有传播。本报告所源自的机构是一家医疗中心，许多献血者同时也是该机构的患者。这为比较献血者问卷回答与病史信息，并将这些结果与HCV检测结果进行关联提供了契机。
对9份来自献血者或曾献血者的储存冷冻血清进行HCV聚合酶链反应（PCR）检测，这些献血者之前的HCV酶免疫测定（EIA，第一代或第二代）及重组免疫印迹测定（RIBA，第一代或第二代）结果呈阳性。同时回顾了23名HCV EIA反复反应性、RIBA阳性献血者中的22名以及88名随机选取的HCV阴性献血者的病史。将生活方式信息与献血者在献血问卷上的回答进行比较。然后将数据与HCV传播给输血受者的现有临床和实验室证据进行关联。
8名献血者没有接受其血液的受者可供评估。在其余15名献血者中，9名有接受HCV检测的受者。这9名献血者中5名的血液受者HCV反复呈反应性；而4名献血者的血液受者则未出现这种情况。献血者PCR阳性与明显传播相关（p = 0.047）。在20名有病史和问卷可供比较的HCV EIA阳性献血者中，12名在其病历中至少有一项提示性的生活方式或既定风险因素，而88名HCV阴性对照者均无（p < 0.0001）。数据未表明有偿献血与未披露这些因素相关。
尽管对献血者的询问更加明确和深入，但仍无法在献血时识别所有可能的风险因素，不过，通过日益敏感的献血者检测，许多未披露所有风险因素的献血者被排除在了献血人群之外。只要检测并非完全万无一失，工作人员就必须警惕获取献血者完整风险信息的能力。需要进一步研究以确定做到这一点的最佳方法。
