Transfusion-associated hepatitis before the screening of blood for hepatitis risk factors.
Transfusion-associated hepatitis before the screening of blood for hepatitis risk factors.
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DOI：
10.1111/trf.12682
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发表时间：
2014-11
期刊：
影响因子：
2.9
通讯作者：
Purcell RH
中科院分区：
文献类型：
--
作者：
Engle RE;Bukh J;Alter HJ;Emerson SU;Trenbeath JL;Nguyen HT;Brockington A;Mitra T;Purcell RH
输血相关性肝炎（TAH）在血液筛查前的真实发病率尚不清楚。我们的目的是重新评估接受未经筛选的血液的血液接受者，并分析超过45年前流行的肝炎病毒。对20世纪60年代接受心脏直视手术的66例患者的冷冻保存血清样本进行了现代诊断试验，以确定TAH的发病率及其病毒学原因。在大量输血的人群中，平均每位患者接受20单位的主要有偿供血，66人中有30人（45%）出现了肝炎的生化证据；其中，20例（67%）单独感染丙型肝炎病毒（HCV）， 4例（13%）单独感染乙型肝炎病毒（HBV）， 6例（20%）同时感染两种病毒。在36例未发生肝炎的患者中，4例（11%）为新近单独感染HCV， 9例（25%）单独感染HBV， 1例（3%）同时感染两种病毒。总体而言，100%的肝炎患者和39%的非肝炎患者感染HBV和/或HCV；1名患者同时感染戊型肝炎病毒。据估计，供者携带HBV和/或HCV的比例超过6%；同时制备的汇集的正常人血浆也被多种肝炎病毒污染。TAH病毒感染是一个比50年前认为的更大的问题，HCV是主要的传播媒介。所有肝炎病例都可归因于丙型肝炎病毒和/或乙型肝炎病毒，因此没有证据表明在血液供应中存在未被发现的其他肝炎病原体。
The true incidence of transfusion-associated hepatitis (TAH) before blood screening is unknown. Our aims were to reevaluate blood recipients receiving unscreened blood and analyze hepatitis viruses circulating more than 45 years ago. Cryopreserved serum samples from 66 patients undergoing open heart surgery in the 1960s were reevaluated with modern diagnostic tests to determine the incidence of TAH and its virologic causes. In this heavily transfused population receiving a mean of 20 units per patient of predominantly paid-donor blood, 30 of 66 (45%) developed biochemical evidence of hepatitis; of these, 20 (67%) were infected with hepatitis C virus (HCV) alone, four (13%) with hepatitis B virus (HBV) alone, and six (20%) with both viruses. Among the 36 patients who did not develop hepatitis, four (11%) were newly infected with HCV alone, nine (25%) with HBV alone, and one (3%) with both viruses. Overall, 100% of patients with hepatitis and 39% of those without hepatitis were infected with HBV and/or HCV; one patient was also infected with hepatitis E virus. The donor carrier rate for HBV and/or HCV was estimated to be more than 6%; contemporaneously prepared pooled normal human plasma was also contaminated with multiple hepatitis viruses. TAH virus infections were a larger problem than perceived 50 years ago and HCV was the predominant agent transmitted. All hepatitis cases could be attributed to HCV and/or HBV and hence there was no evidence to suggest that an additional hepatitis agent existed undetected in the blood supply.