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Targeted hepatitis C lookback: Quebec, Canada
1Canadian Red Cross Society, Blood Services, Transfusion Center of Quebec, Montreal.
Insights
Canadian blood donations are screened for hepatitis C virus (HCV). Targeted HCV lookback studies identified 101 recipients unaware of their infection, highlighting the importance of donor screening and recipient notification.
Area of Science:
- Transfusion Medicine
- Hepatology
- Public Health
Background:
- Canadian blood donations have been screened for hepatitis C virus (HCV) antibodies since March 1990.
- Targeted HCV lookback studies were initiated in February 1995 due to the potential for chronic, asymptomatic HCV infection.
Purpose of the Study:
- To assess the effectiveness and outcomes of targeted hepatitis C virus (HCV) lookback studies in Quebec.
- To evaluate the resources and costs associated with implementing HCV lookback programs in hospital settings.
Main Methods:
- Analysis of 3,196 blood components issued from anti-HCV-positive donors between March 1990 and March 1997.
- Survey of 109 hospitals to determine lookback procedures and resource allocation.
- Development of a standard operating procedure for lookbacks at the Royal Victoria Hospital (RVH) and cost-outcome analysis.
Main Results:
- Information was received for 73% of components; 353 patients were tested.
- Of those tested, 215 (61%) were anti-HCV positive. At RVH, 9 previously undiagnosed seropositive recipients were identified from 182 components.
- The cost per newly diagnosed HCV case ranged from $2727 (Quebec Center) to $6014 (RVH).
Conclusions:
- Targeted lookback studies on 3,196 components in Quebec identified 101 recipients unaware of their HCV status.
- The study underscores the value of lookback programs in identifying undiagnosed HCV infections among transfusion recipients.
Background:
Since March 1990, all blood donations in Canada are screened for antibodies to hepatitis C virus (HCV). Because HCV may cause chronic asymptomatic hepatitis, in February 1995, the Canadian Red Cross began targeted HCV lookback studies.
Study Design And Methods:
From March 1990 to March 1997, the Quebec Center of the Canadian Red Cross collected 1,750,846 donations, and there were 561 anti-HCV-positive repeat donors, from whom 3,196 blood components had been issued to the hospitals. Hospital blood bank directors were asked to test recipients and return results to the Quebec Center. One hundred nine hospitals were surveyed to determine methods and resources involved in lookback. The transfusion medicine service at the Royal Victoria Hospital (RVH) developed a standard operating procedure for performing lookbacks and analyzed the costs and outcomes of lookbacks.
Results:
As of April 1998, information has been received on 2329 (73%) of components; 1020 patients had died of unrelated causes, 590 were untraceable, and 353 were tested. Of those tested, 215 (61%) were anti-HCV positive; their average age was 47, and at least 53 percent were already aware of their HCV status. Few hospitals had received any additional resources to perform lookbacks. At the RVH, lookback on 182 components resulted in the identification of nine seropositive recipients, average age 70, who did not previously know their HCV status; four of these patients had abnormal alanine aminotransferase levels. The cost of lookback per newly diagnosed case of HCV was estimated at $2727 (US) for the Quebec Center and $6014 (US) for the RVH.
Conclusion:
Targeted lookback in the province of Quebec on 3196 components has resulted in the identification of 101 seropositive recipients who did not previously know their HCV status.