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International review of blood donation screening for anti-HBc and occult hepatitis B virus infection
Journal article   Open access   Peer reviewed

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

Michael X. Fu, Helen M. Faddy, Daniel Candotti, Jamel Groves, Paula Saa, Claire Styles, Opeyemi Adesina, Jose Perez Carrillo, Axel Seltsam, Marijke Weber-Schehl, …
Transfusion, Vol.64(11), pp.2144-2156
2024
PMID: 39359112
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Transfusion - 2024 - Fu - International review of blood donation screening for anti‐HBc and occult hepatitis B virus2.15 MBDownloadView
Published Version Open Access CC BY V4.0

Abstract

anti-HBc testing blood transfusion HBV screening NAT safety
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.

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