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Frequency of hepatitis B after open heart surgery: a retrospective study over a three-year period (1974--1976)
Insights
Implementing rigorous blood donor screening significantly reduced hepatitis B infection rates in open-heart surgery patients. This careful donor selection and testing program proved effective in preventing post-operative hepatitis B complications.
Area of Science:
- Cardiology
- Hepatology
- Infectious Disease Epidemiology
Background:
- Hepatitis B poses a significant risk for patients undergoing open-heart surgery, with infection rates historically exceeding 40% despite preventative measures.
- Post-operative hepatitis B complications present a persistent challenge in cardiac surgery settings.
Purpose of the Study:
- To evaluate the impact of enhanced blood donor selection and screening protocols on reducing hepatitis B incidence in open-heart surgery patients.
- To assess the effectiveness of a comprehensive donor surveillance program implemented between 1974 and 1976.
Main Methods:
- A retrospective analysis of 588 open-heart surgery patients from 1974 to 1976.
- Implementation of stringent blood donor selection criteria including clinical observation, chest X-rays, BSR, hemoglobin, aminotransferase, TPHA tests, and antibody screening.
- Utilized reverse hemagglutination tests in 1974 and modified radioimmunoassay since 1975 for hepatitis B surface antigen (HBsAg) detection.
- Transfusion of donor blood with abnormal results was strictly avoided, except in critical emergencies.
Main Results:
- Hepatitis B frequency decreased from 2.0% in 1974 to 0.6% in 1975 and 1976.
- Non-B hepatitis incidence was also observed at 0.6% in 1975 and 1976.
- The study observed a significant reduction in hepatitis B cases following the implementation of the new donor screening protocols.
Conclusions:
- A rigorous program of careful blood donor selection and continuous monitoring is highly effective in preventing hepatitis B transmission in cardiac surgery.
- The use of sensitive detection methods like radioimmunoassay for HBsAg and avoiding pooled preparations are crucial for minimizing transfusion-associated hepatitis.
- The observed decline in hepatitis B rates highlights the success of the implemented donor surveillance strategy.
Abstract:
In spite of intensive efforts to reduce the risk of hepatitis B after heart operations, this complication is observed in 40 % or more of the cases. Over a period of three years (1974--1976) we examined 588 patients who had undergone open heart surgery. The following results were found: In 1974 the hepatitis frequency was 2.0 %, while in 1975 and 1976 it was 0.6 % hepatitis B and 0.6 % non-B hepatitis. We believe the reason for this improvement is a more careful selection of blood donors and their continuous control according to the following parameters: regular clinical observation; regular chest x-ray; determination of BSR, hemoglobin and aminotransferase; TPHA test; and search for antibodies. In 1974 hepatitis-B-surface-antigen (HBsAg) was detected by means of reverse hemagglutination tests. Since 1975 a modified radioimmunoassay has been used for this purpose. No donor blood with abnormal results was transfused, except for a very small number of extreme emergencies. The good results demonstrated can only be obtained by following the described program and by strictly avoiding pool preparations.