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Transfusion Transmitted Hepatitis

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2. Transfusion Transmitted Hepatitis

Subsequent to the mandatory screening of blood for hepatitis B virus (HBsAg), the incidence of post-transfusion hepatitis due to HBV has dramatically dropped. Now the data from western countries suggest that more than 90% of post-transfusion hepatitis is caused by a group of viruses designated as Non-A non-B viruses, one of which is Hepatitis C virus.

Transfusion Transmitted Hepatitis

Disease	Agent	Incidence % PTH	Chronic Hepatitis
Hepatitis B infection	HBV	15-25%	6-10%
Non-A Non-B hepatitis or other viruses	HNANB/HCV	70-90%	30-50%
Hepatitis A infection	HAV	rare	0%
CMV hepatitis	CMV	rare	0%
EBV hepatitis	EBV	rare	0%
Hepatitis D infection	HDV plus HBV	rare	0%

The Infectious agent

HBV is a 42 nm complete DNA virus known as the Dane particle and consists of an inner protein core (HBc) containing partially double-stranded DNA & DNA polymerase (27 mm in diameter) surrounded by an outer coat of hepatitis B surface antigen (HBsAg). HBsAg is shed into plasma in large quantities in the form of rods & spheres (diameter 18-22 nm). Antibodies to the HBsAg & I-lBcAg are known as anti-HBs and anti-HBc respectively.

Clinical course of HBV infection

Jaundice develops 50-180 days after infection, preceded by elevation of alanine aminotransferase(ALT) and the occurence of antigenemia of 1-IBsAg & HBeAg. Both antigens disappear in approximately 4-6 weeks. The antibodies to HBc appears earliest, followed by the appearance of anti-HBe.

Anti-HBs is detectable after another 4-8 weeks. Both anti-I-lBs & anti-HBc may persist for years indicating a previous hepatitis B infection. In a self-limiting acute hepatitis B infection, I-lBsAg remains detectable from a few days to several months, while in chronic infection HBsAg remains detectable for many years, perhaps for the entire life of the individual.

Window period

Sometimes appearance of anti-HBs may be delayed for weeks to months after I-lBsAg becomes indetectable, during this period called as �core antibody window period�. anti-HBc may be the only detectable market indicating a recent HBV infection. Therefore, screening for anti-HBc during this period may reduce the incidence of post-transfusion hepatitis due to hepatitis B virus.

Risk of transmission

As the HBV is plasma-borne, it can easily be transmitted by all blood components and most blood products (e.g. factor VIII). The risk of transmission is increased when plasma is pooled for the manufacture of plasma products.

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