Is it okay to transfuse someone with hepatitis?

From the Guidelines

Transfusing blood from a donor with hepatitis to a recipient is not acceptable due to the high risk of disease transmission. Blood banks and transfusion services routinely screen all donated blood for hepatitis B virus (HBV), hepatitis C virus (HCV), and other infectious agents to prevent transmission, as noted in a study from 1. The risk of transmitting HBV via transfusion of whole blood and blood components has been significantly reduced in the United States due to donor selection procedures and routine testing of donors, with no infections attributable to blood products received during 1998-2002 among persons with bleeding disorders treated at U.S. hemophilia treatment centers 1.

Key Considerations

• The concern with hepatitis viruses is that they can cause acute and chronic liver inflammation, potentially leading to cirrhosis, liver failure, or liver cancer in recipients.
• Some patients with hepatitis may be asymptomatic carriers who can still transmit the disease.
• Blood transfusion safety protocols exist specifically to prevent the transmission of infectious diseases like hepatitis, HIV, and other pathogens, making the intentional transfusion of hepatitis-infected blood contrary to standard medical practice and patient safety principles, as supported by recommendations from 1.

Clinical Implications

• In emergency situations where the recipient has the same type of hepatitis as the potential donor, a case-by-case risk assessment might be made, but this is extremely rare and would only be considered if the benefits clearly outweigh the risks.
• The use of viral inactivation procedures and recombinant clotting factor concentrates has eliminated the transmission of HBV among persons with hemophilia who received plasma-derived clotting factor concentrates, as reported in 1.
• The risk of HCV transmission by blood transfusion has also been significantly reduced, with a risk of approximately 0.02%/unit transfused by 1990, and further reduced with the initiation of routine testing of donors for evidence of HCV infection in 1990 1.

From the Research

Risks of Transfusion-Transmitted Hepatitis

• The risk of transmitting hepatitis B virus (HBV) and hepatitis C virus (HCV) through blood transfusion has been significantly reduced due to improved donor selection and screening criteria, as well as advances in testing for viral hepatitis carriers 2, 3.
• The current risks of transfusion-associated hepatitis are extremely small, with the risk of HBV transmission estimated to be around 1 in 63,000 units of blood and the risk of HCV transmission estimated to be around 1 in 125,000 units of blood 3, 4.
• The use of tests such as hepatitis B surface antigen, hepatitis C virus antibody, hepatitis B core antibody, and alanine aminotransferase has contributed to the reduction in transfusion-transmitted hepatitis 2, 3, 5.

Factors Affecting Transfusion-Transmitted Hepatitis

• The incubation time, infectivity during the silent phase, and sensitivity of screening procedures all play a role in determining the risk of transfusion-transmitted hepatitis 2.
• The use of nucleic acid amplification techniques, such as polymerase chain reaction, may further reduce the risks of transfusion-associated hepatitis, but these tests are not yet licensed and practical for individual blood donor screening 3.
• The immune status of blood recipients should be taken into consideration when investigating post-transfusion HBV infection, as immunodeficient individuals may be more susceptible to infection 6.

Prevention and Reduction of Transfusion-Transmitted Hepatitis

• Restricting transfusions to those that are necessary or appropriate, utilizing alternatives to transfusion, and employing novel assays to detect viral nucleic acids may help to further reduce the risks of HBV and HCV transmission by transfusions 4.
• The implementation of HBV nucleic acid testing (NAT) may significantly reduce the window period and detect occult HBV carriage, substantiating decades of clinical observation that HBsAg-negative/anti-HBc-positive blood could transmit HBV 6.