Barker L F, Gerety R J
Prog Clin Biol Res. 1976;11:163-82.
Although blood banks in this country have been testing every unit of blood for hepatitis B surface antigen (HBSAg) by one of the highly sensitive "third generation" methods (radioimmunoassay or reversed passive hemagglutination) since September, 1975, post-transfusion hepatitis (PTH) still remains the major hazard to patients who require transfusion with blood and blood products. Since there may be an interval of many months between transfusion and onset of PTH and many cases are subclinical, the best data on the incidence of PTH have come from prospective studies with careful follow-up of transfused patients. Such studies first established the validity of HBSAg as a marker for the presence of hepatitis B virus (HBV), and they have shown a dramatic reduction in the incidence of post-transfusion type B hepatitis following the elemination of HBSAg positive blood from transfusion. Nevertheless, PTH cases not associated with HBV or HAV, which are termed non-A, non-B hepatitis, continue to occur commonly among transfused patients. Non-A, non-B hepatitis appears to be subclinical in many instances, but it can produce prolonged persistence of abnormal liver function tests, which may be associated with chronic liver disease. The outstanding risk factor responsible for the development of PTH has been shown to be blood from paid donors in every study which has evaluated this factor. HBSAg and anti-HBS prevalences were found to be much higher in paid donor groups than in voluntary donors. Accordingly, the Food and Drug Administration has proposed that all units of blood be labeled to indicate whether they were collected from voluntary or paid donors in order to inform consumers of the relative hepatitis risks of blood units from these different donor populations. In addition to HBSAg testing and reduced use of blood from paid donors, measures which may provide future reduction of the hepatitis hazard associated with blood transfusion include avoidance of unnecessary transfusions, identification of the agent(s) responsible for non-A non-B hepatitis and development of tests for these agents, idenfification and avoidance of blood from donors implicated in PTH cases, development of methods for immunizing transfused patients against the various agents responsible for PTH, and use of frozen-washed red blood cells for transfusion. Efforts to develop and/or evaluate these various approaches are currently being actively pursued in many laboratories.
自1975年9月以来，该国的血库一直使用高度敏感的“第三代”方法（放射免疫测定法或反向被动血凝法）对每单位血液进行乙肝表面抗原（HBSAg）检测，但输血后肝炎（PTH）仍然是需要输血和血液制品的患者面临的主要风险。由于输血与PTH发病之间可能间隔数月，且许多病例为亚临床病例，关于PTH发病率的最佳数据来自对输血患者进行仔细随访的前瞻性研究。此类研究首先证实了HBSAg作为乙肝病毒（HBV）存在标志物的有效性，并且它们表明，在从输血中剔除HBSAg阳性血液后，输血后B型肝炎的发病率显著降低。然而，与HBV或HAV无关的PTH病例，即所谓的非甲非乙型肝炎，在输血患者中仍普遍发生。非甲非乙型肝炎在许多情况下似乎是亚临床的，但它可导致肝功能检查异常持续很长时间，这可能与慢性肝病有关。在每项评估该因素的研究中，已证明导致PTH发生的突出风险因素是有偿供血者的血液。在有偿供血者群体中发现HBSAg和抗-HBS的流行率远高于自愿供血者。因此，食品药品管理局提议对所有血液单位进行标记，以表明它们是从自愿供血者还是有偿供血者采集的，以便让消费者了解来自这些不同供血人群的血液单位的相对肝炎风险。除了进行HBSAg检测和减少使用有偿供血者的血液外，未来可能降低与输血相关的肝炎风险的措施包括避免不必要的输血、确定导致非甲非乙型肝炎的病原体并开发针对这些病原体的检测方法、识别并避免使用与PTH病例有关的供血者的血液、开发使输血患者对导致PTH的各种病原体产生免疫的方法以及使用冷冻洗涤红细胞进行输血。目前许多实验室正在积极致力于开发和/或评估这些各种方法。
