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[Frequency of hepatitis after extra-corporeal circulation]
Insights
Systematic screening for hepatitis B (HB) virus in blood donors significantly reduced icteric hepatitis after cardiovascular surgery. More sensitive tests are crucial for preventing viral hepatitis transmission via blood transfusions.
Area of Science:
- Hepatology
- Virology
- Cardiovascular Surgery
Context:
- Hepatitis B virus (HBV) transmission poses a risk in cardiovascular surgery, particularly after extracorporeal circulation (ECC).
- Assessing the efficacy of hepatitis B surface antigen (HBsAg) screening in blood donors is critical for patient safety.
- Previous screening methods showed varying effectiveness in preventing post-transfusion hepatitis.
Purpose:
- To evaluate the impact of systematic HBsAg screening in blood donors on the incidence of icteric hepatitis following ECC.
- To compare the effectiveness of different HBsAg screening techniques (immuno-diffusion, counter-electrophoresis, complement fixation) in reducing viral hepatitis transmission.
- To identify patient demographics associated with a higher risk of post-transfusion hepatitis.
Summary:
- The study analyzed three groups of patients undergoing ECC: no screening, immuno-diffusion screening, and advanced screening (counter-electrophoresis, complement fixation).
- Incidence of icteric hepatitis decreased from 6.7% without screening to 4.6% with systematic advanced screening.
- Hepatitis was more frequent in males and older patients; recovery was typically within 2 months, but severe and fatal cases occurred.
Impact:
- Systematic HBsAg screening, especially using sensitive methods like radio-immuno-assay and reverse passive haemagglutination, is essential to minimize post-transfusion hepatitis risk.
- Current screening tests are effective against HBV but may not prevent transmission of other hepatitis virus strains.
- The findings advocate for the daily use of the most sensitive HBsAg screening tests in blood banks to enhance transfusion safety.
Abstract:
In cardio-vascular surgery the risk that the hepatitis-B (H.B.) virus be transmitted was measured in 3 groups of patients (Professor Ch. Dubost), before and since systematic screening for HBS antigen in donors' blood. The same questionnaire was sent to each patient in each group 6 months after extra-corporeal-circulation (ECC), in order to determine the efficiency of HB virus screening tests. The present study gives the following results: --in the first group (no screening for HBS antigen in donors' blood), the frequency of icteric hepatitis was 6.7% (26 cases of jaundice, probably due to hepatitis viruses, out of 386 ECC); --in the second group (screening for HBS antigen in donors' blood by immuno-diffusion (often made after transfusion of fresh blood) the frequency of icteric hepatitis after transfusion of HBS antigen positive blood); --in the third groups, icteric hepatitis was less frequent (4.6%) since systematic screening for HBS antigen by counter-electrophoresis and complement fixation was performed (29 cas out of 629 ECC). Additionally, viral hepatitis appeared more frequently in men than in women, and among older patients than younger ones. Recovery was generally complete in 2 months; however, the evolution of the disease was severe in 3 cases and fatal in one case. In sum, after ECC, hepatitis still remains a frequent side-effect, compelling blood centers to use th most sensitive screening tests now available for HBS screening: radio-immuno-assay and reverse passive haemagglutination tests. As a consequence of the present study, these 2 techniques are being applied on a daily basis in our laboratory for HBS antigen screening tests are ineffective in preventing the transmission of other strains of viral hepatitis by blood transfusion.