HEPATITIS C-RELATED CHRONIC LIVER-DISEASE AMONG ASYMPTOMATIC BLOOD-DONORS IN THE NORTH-WEST OF ENGLAND

In the first 19 months of screening, the North Western Regional Transf usion Centre (RTC) tested 224 700 consecutive blood donors for antibod y to hepatitis C virus (anti-HCV) by second generation enzyme immunoas say (EIA). Of these, 366 repeatedly reactive samples were referred for confirmatory testing at Manchester Public Health Laboratory (PHL). Th ere, the initial EIA was repeated, together with two further EIAs. All the referred samples were subjected to a confirmatory line immunoblot (RIBA-II). Reverse transcription followed by the polymerase chain rea ction (RT-PCR), in order to detect viral RNA, was performed on selecte d samples. Among the donors, 61 accepted offers for medical review and were assessed for risk factors, clinical findings and results of stan dard liver function tests. Of these donors, 53 proceeded to liver biop sy. The overall prevalence of confirmed positive donors was 0.04%. Mai n risk factors identified included intravenous drug abuse in 31 (51%) donors and prior blood transfusion in 12 (20%) but a risk factor was n ot apparent in 11 (18%). Viraemia, detected by RT-PCR, could be predic ted with a high degree of accuracy by means of the readily available a nd simpler screening and confirmatory tests (EIA and RIBA-II). Establi shed chronic hepatitis was demonstrated in 90% of the liver biopsies. A trend towards worsening histological findings accompanied increasing concentrations of serum transaminase. Even so, many donors with norma l transaminase values had abnormal biopsies including those showing ch ronic active hepatitis (CAH). These findings indicate that a substanti al proportion of previously unrecognised asymptomatic persons with est ablished chronic liver disease exists among North Western blood donors . Confirmed positive serological tests are usually associated with vir aemia and abnormal histological findings. We conclude that all such co nfirmed positive persons should be offered full medical assessment, in cluding liver biopsy, so as to determine whether they warrant antivira l therapy.