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The Impact of Donor Selection in Avoiding Hepatitis Virus Transmission
Author(s) -
Warson S I
Publication year - 1984
Publication title -
scandinavian journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0036-553X
DOI - 10.1111/j.1600-0609.1984.tb02578.x
Subject(s) - medicine , hbsag , hepatitis b , transmission (telecommunications) , hepatitis virus , incidence (geometry) , hepatitis b virus , clotting factor , hepatitis , immunology , intensive care medicine , virus , virology , physics , optics , electrical engineering , engineering
Concerning hepatitis B one remaining problem is the occurrence of so called “low‐level” hepatitis B virus carriers who are HBsAg‐negative by routine RIA‐testing but positive when the sample is retested for instance after pepsin digestion and polyethyleneglycol precipitation. A simple and reproducible technique for the detection of these low‐level HBV carriers would be of great value. IgM anti‐HBc does not seem to accomplish this purpose. For the detection of non‐A, non‐B hepatitis viruses, reliable techniques are still lacking. ALT‐determinations are not ideal and the reported prevalence of non‐A, non‐B virus carriers among donors based on ALT‐elevation studies in recipients may be an overestimation. An upcoming problem if and when ALT‐screening will be introduced is the significant number of donors with ALT‐elevations. What are we going to tell them? What are we going to do with them in terms of medical evaluation? These are questions which ought to be answered before large‐scale ALT‐screening is introduced. Furthermore, no randomized study has shown that exclusion of blood from donors with ALT‐elevations lowers the incidence of post‐transfusion hepatitis. The use of as small donor populations as possible and preferably volunteer donors of high socio‐economic status when manufacturing clotting factor concentrates is of course of utmost importance for patients with severe hemophilia who need these products. In patients with infrequent bleeding episodes who requires treatments for special situations only, the “small pool concept” in preparation of cryoprecipitates ought to be generally accepted. The use of DDAVP preparations in donors and in hemophiliacs who have some endogenous activity of F VIII in order to increase the yield or decrease the demand, respectively, is interesting and may possibly reduce the number of donors required for production of F VIII concentrates.