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. 2024 Sep;64(9):1612-1615.
doi: 10.1111/trf.17938. Epub 2024 Jul 10.

Hepatitis B screening in hematology patients receiving intravenous immunoglobulin

K Liston  1 , A R Prior  2 , J McHugh  1 , H Enright  1 , R Desmond  1
Affiliations

Hepatitis B screening in hematology patients receiving intravenous immunoglobulin

K Liston et al. Transfusion. 2024 Sep.

Abstract

Background: Transient positivity for hepatitis B core antibody (Anti-HBc) following intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin exposure is a well-described phenomenon. The aim of this study was to retrospectively review Hepatitis B viral screening practices in IVIG recipients in a hematology specific cohort at a single center.

Methods: Electronic databases were analyzed to identify all hematology patients who received IVIG from September 2022 to March 2022 at a single Irish center (n = 43). The proportion of patients that had a baseline anti-HBc tested prior to IVIG receipt was assessed as well as the proportion of patients that developed a transiently positive anti-HBc following IVIG exposure. Data were also collected relating to signal cut-off ratios in patients with detectable anti-HBc post-IVIG.

Results: 58.1% of patients had at least one serological hepatitis B viral test sent prior to IVIG exposure. Anti-HBc was the least common serological investigation performed prior to IVIG exposure (21% of recipients). A positive or equivocal "low level antibody" was identified in 15% of recipients and this was proven to be transient in all cases.

Conclusion: The minority of hematology patients had a baseline anti-HBc assessed prior to IVIG exposure. All patients in this study had the potential to require further immunosuppressive therapies, which could be limited by a misleading anti-HBc result. We therefore advocate for baseline anti-HBc testing to be performed prior to IVIG exposure in hematology patients and for cautious interpretation of anti-HBc results taking into account signal cut-off ratios post-IVIG exposure.

Keywords: infectious disease testing; intravenous immunoglobulin; transfusiontransmitted disease—hepatitis.

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References

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