Review

. 2024 Nov;64(11):2144-2156.

doi: 10.1111/trf.18018. Epub 2024 Oct 2.

International review of blood donation screening for anti-HBc and occult hepatitis B virus infection

Michael X Fu¹, Helen M Faddy^{2

3}, Daniel Candotti⁴, Jamel Groves⁵, Paula Saa⁵, Claire Styles⁶, Opeyemi Adesina⁷, Jose Perez Carrillo^{8

9}, Axel Seltsam¹⁰, Marijke Weber-Schehl¹⁰, Sheila F O'Brien¹¹, Steven J Drews¹¹, Nana Benyin Aidoo¹², Ángel Luis Pajares¹³, Laura Navarro Perez¹⁴, Xuelian Deng¹⁵, Thijs van de Laar¹⁶, Syria Laperche¹⁷, Riikka Lehtisalo¹⁸, Soner Yilmaz¹⁹, Wai-Chiu Tsoi²⁰, David Juhl²¹, Christoph Niederhauser^{22

23}, Nahid Chenarsabz²⁴, Niamh O'Flaherty²⁵, Naoko Goto²⁶, Masahiro Satake²⁶, Christian Renaud²⁷, Antoine Lewin²⁷, Marc Cloutier²⁷, Salam Sawadogo²⁸, Claire Reynolds²⁹, Eugene Zhiburt³⁰, An Muylaert³¹, Véronique Van Gaever³¹, Michel-Andres Garcia-Otalora³², Lisa Jarvis³³, Marion Vermeulen^{34

35}, Michael Busch³⁶, Stuart Blackmore³⁷, Ann Jones³⁷, Su Brailsford²⁹, William L Irving³⁸, Monique Andersson^{39

40}, Peter Simmonds¹, Heli Harvala^{29

40}; Virology subgroup of the ISBT WP‐TTID

Affiliations

¹ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
² School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia.
³ Research and Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia.
⁴ Institut Mondor de Recherche Biomédicale, INSERM U955, Team Virus-Hepatology-Cancer, Henri Mondor Hospital, University Paris-Est, Créteil, France.
⁵ American Red Cross, Baltimore, Maryland, USA.
⁶ Australian Red Cross Lifeblood, Melbourne, Australia.
⁷ Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
⁸ Banco de Sangre Laboratorio Clínico, Clínica Colsanitas. Grupo de Investigación-INPAC, Bogotá, Colombia.
⁹ Departamento de Posgrado en Enfermedades Infecciosas, Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Bucaramanga, Colombia.
¹⁰ Bavarian Red Cross Blood Service, Institute Nuremberg, Germany.
¹¹ Canadian Blood Services, Canada.
¹² Cape Coast Teaching Hospital, Diagnostic SUB-BMC, Ghana.
¹³ Centro de Transfusión de la Comunidad de Madrid, Spain.
¹⁴ Centro de Transfusión de la Comunidad Valenciana, Spain.
¹⁵ Dalian Blood Centre, Dalian, China.
¹⁶ Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.
¹⁷ Etablissement Français du Sang, La Plaine Saint Denis, France.
¹⁸ Finnish Red Cross Blood Service, Helsinki, Finland.
¹⁹ Gülhane Regional Blood Center, Turkey.
²⁰ Hong Kong Red Cross Blood Transfusion Service, Hong Kong.
²¹ Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Germany.
²² Interregional Blood Transfusion SRC, Switzerland.
²³ Institute for Infectious Diseases, University of Berne, Berne, Switzerland.
²⁴ Iranian Blood Transfusion Organization, Iran.
²⁵ Irish Blood Transfusion Service, Dublin, Ireland.
²⁶ Japanese Red Cross Blood Service, Japan.
²⁷ Medical Affairs and Innovation, Hema-Quebec, Canada.
²⁸ National Blood Transfusion Center of Burkina Faso, Burkina Faso.
²⁹ NHS Blood and Transplant, UK.
³⁰ Pigorov National Medical Surgical Center, Russia.
³¹ Red Cross Flanders, Belgium.
³² School of Medicine and Health Science, Universidad del Rosario, Bogotá, Colombia.
³³ Scottish National Blood Transfusion Service, Edinburgh, UK.
³⁴ The South African National Blood Service, South Africa.
³⁵ University of the Free State, South Africa.
³⁶ Vitalant Research Institute, San Francisco, California, USA.
³⁷ Welsh Blood Service, Wales, UK.
³⁸ NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
³⁹ Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴⁰ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.

PMID: 39359112
DOI: 10.1111/trf.18018

Free article

Review

International review of blood donation screening for anti-HBc and occult hepatitis B virus infection

Michael X Fu et al. Transfusion. 2024 Nov.

Free article

. 2024 Nov;64(11):2144-2156.

doi: 10.1111/trf.18018. Epub 2024 Oct 2.

Authors

Affiliations

¹ Nuffield Department of Medicine, University of Oxford, Oxford, UK.
² School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia.
³ Research and Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia.
⁴ Institut Mondor de Recherche Biomédicale, INSERM U955, Team Virus-Hepatology-Cancer, Henri Mondor Hospital, University Paris-Est, Créteil, France.
⁵ American Red Cross, Baltimore, Maryland, USA.
⁶ Australian Red Cross Lifeblood, Melbourne, Australia.
⁷ Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.
⁸ Banco de Sangre Laboratorio Clínico, Clínica Colsanitas. Grupo de Investigación-INPAC, Bogotá, Colombia.
⁹ Departamento de Posgrado en Enfermedades Infecciosas, Facultad de Ciencias Médicas y de la Salud, Universidad de Santander, Bucaramanga, Colombia.
¹⁰ Bavarian Red Cross Blood Service, Institute Nuremberg, Germany.
¹¹ Canadian Blood Services, Canada.
¹² Cape Coast Teaching Hospital, Diagnostic SUB-BMC, Ghana.
¹³ Centro de Transfusión de la Comunidad de Madrid, Spain.
¹⁴ Centro de Transfusión de la Comunidad Valenciana, Spain.
¹⁵ Dalian Blood Centre, Dalian, China.
¹⁶ Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.
¹⁷ Etablissement Français du Sang, La Plaine Saint Denis, France.
¹⁸ Finnish Red Cross Blood Service, Helsinki, Finland.
¹⁹ Gülhane Regional Blood Center, Turkey.
²⁰ Hong Kong Red Cross Blood Transfusion Service, Hong Kong.
²¹ Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Germany.
²² Interregional Blood Transfusion SRC, Switzerland.
²³ Institute for Infectious Diseases, University of Berne, Berne, Switzerland.
²⁴ Iranian Blood Transfusion Organization, Iran.
²⁵ Irish Blood Transfusion Service, Dublin, Ireland.
²⁶ Japanese Red Cross Blood Service, Japan.
²⁷ Medical Affairs and Innovation, Hema-Quebec, Canada.
²⁸ National Blood Transfusion Center of Burkina Faso, Burkina Faso.
²⁹ NHS Blood and Transplant, UK.
³⁰ Pigorov National Medical Surgical Center, Russia.
³¹ Red Cross Flanders, Belgium.
³² School of Medicine and Health Science, Universidad del Rosario, Bogotá, Colombia.
³³ Scottish National Blood Transfusion Service, Edinburgh, UK.
³⁴ The South African National Blood Service, South Africa.
³⁵ University of the Free State, South Africa.
³⁶ Vitalant Research Institute, San Francisco, California, USA.
³⁷ Welsh Blood Service, Wales, UK.
³⁸ NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
³⁹ Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁴⁰ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.

PMID: 39359112
DOI: 10.1111/trf.18018

Erratum in

Correction to "International review of blood donation screening for anti-HBc and occult hepatitis B virus infection".
[No authors listed] [No authors listed] Transfusion. 2025 Mar;65(3):648. doi: 10.1111/trf.18094. Epub 2025 Jan 22. Transfusion. 2025. PMID: 39844385 No abstract available.

Abstract

Background: Hepatitis B core antibody (anti-HBc) screening has been implemented in many blood establishments to help prevent transmission of hepatitis B virus (HBV), including from donors with occult HBV infection (OBI). We review HBV screening algorithms across blood establishments globally and their potential effectiveness in reducing transmission risk.

Materials and methods: A questionnaire on HBV screening and follow-up strategies was distributed to members of the International Society of Blood Transfusion working party on transfusion-transmitted infectious diseases. Screening data from 2022 were assimilated and analyzed.

Results: A total of 30 unique responses were received from 25 countries. Sixteen respondents screened all donations for anti-HBc, with 14 also screening all donations for HBV DNA. Anti-HBc prevalence was 0.42% in all blood donors and 1.19% in new donors in low-endemic countries; however, only 44% of respondents performed additional anti-HBc testing to exclude false reactivity. 0.68% of anti-HBc positive, HBsAg-negative donors had detectable HBV DNA. Ten respondents did universal HBV DNA screening without anti-HBc, whereas four respondents did not screen for either. Deferral strategies for anti-HBc positive donors were highly variable. One transfusion-transmission from an anti-HBc negative donor was reported.

Discussion: Anti-HBc screening identifies donors with OBI but also results in the unnecessary deferral of a significant number of donors with resolved HBV infection and donors with false-reactive anti-HBc results. Whilst confirmation of anti-HBc results could be improved to reduce donor deferral, transmission risks associated with anti-HBc negative OBI donors must be considered. In high-endemic areas, highly sensitive HBV DNA testing is required to identify infectious donors.

Keywords: HBV screening; NAT; anti‐HBc testing; blood transfusion; safety.

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References

REFERENCES

1. Hollinger FB, Dodd RY. Hepatitis B virus traceback and lookback: factors to consider. Transfusion. 2009;49(1):176–184. https://doi.org/10.1111/J.1537-2995.2008.01961.X
1. Candotti D, Assennato SM, Laperche S, Allain JP, Levicnik‐Stezinar S. Multiple HBV transfusion transmissions from undetected occult infections: revising the minimal infectious dose. Gut. 2019;68(2):313–321. https://doi.org/10.1136/GUTJNL-2018-316490
1. Harvala H, Reynolds C, Gibney Z, Derrick J, Ijaz S, Davison KL, et al. Hepatitis B infections among blood donors in England between 2009 and 2018: is an occult hepatitis B infection a risk for blood safety? Transfusion. 2021;61(8):2402–2413. https://doi.org/10.1111/TRF.16543
1. Raimondo G, Locarnini S, Pollicino T, Levrero M, Zoulim F, Lok AS, et al. Update of the statements on biology and clinical impact of occult hepatitis B virus infection. J Hepatol. 2019;71(2):397–408. https://doi.org/10.1016/J.JHEP.2019.03.034
1. Lelie N, Busch M, Kleinman S. Residual risk of transfusion‐transmitted hepatitis B virus (TT‐HBV) infection by NAT‐screened blood components: a review of observed versus modeled infectivity from donors with window period and occult HBV infections. Transfusion. 2021;61(11):3190–3201. https://doi.org/10.1111/TRF.16675

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International review of blood donation screening for anti-HBc and occult hepatitis B virus infection

Affiliations

International review of blood donation screening for anti-HBc and occult hepatitis B virus infection

Authors

Affiliations

Erratum in

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical