Post-transfusion hepatitis: current risks and causes

Abstract

Viral hepatitis which follows transfusions (post-transfusion hepatitis) may be due to those transfusions, i.e., transfusion-transmitted hepatitis (TTH), or may be incident to the reason for the transfusion and, thus, may be transfusion-associated, but not transfusion-transmitted. The current risks of TTH, today, are extremely small, but are still due, primarily, to the hepatitis B virus (HBV) and the hepatitis C virus (HCV), the latter, formerly being known as "non-A, non-B hepatitis." The residual, now, of TTH which is non-A, non-B, and non-C is extremely small and may be due to a variety of agents. Using volunteer (unpaid), repeat, blood donors, who are carefully screened for hepatitis risk factors and then tested for evidence of HBV infection, the risk of HBV being transmitted by a transfusion today is in the order of 1 per 63,000 units of blood. For transfusion-transmitted HCV, with the same repeat, volunteer (unpaid) donors, careful screening and a sensitive assay for anti-HCV, the risk is in the order of 1 in 125,000 units. These risks of HBV and HCV due to transfusions are so small that other means of acquiring these viruses should be sought when patients develop hepatitis following blood transfusions. However, efforts to further reduce the current risks of HBV and HCV transmission by transfusions should continue; these include restricting transfusions to those which are necessary or appropriate, utilizing alternatives to transfusion, employing novel assays to detect viral nucleic acids, and, finally, implementing various microbial inactivation techniques on blood, blood components and plasma derivatives.