THE HISTOPATHOLOGICAL FEATURES OF ASYMPTOMATIC HEPATITIS-C VIRUS-ANTIBODY POSITIVE BLOOD-DONORS

Since the introduction of screening for hepatitis C virus (HCV) in don ated blood, the risk of contracting posttransfusion hepatitis has been greatly reduced and the test has led to the recognition of asymptomat ic blood donors positive for anti-HCV antibodies. Following confirmati on of the HCV status with second generation RIBA testing followed by c ounselling, 55 patients had full investigations, including liver biops y. These were classified by the traditional chronic hepatitis system a nd were graded according to the Knodell and Scheuer histological activ ity indices. Seven of the biopsies were normal (12%), apart from minor degrees of steatosis in two. Eleven cases (20%) were in the chronic l obular hepatitis category without portal inflammation, while 37 cases showed portal inflammation, including 20 (36%) cases where chronic per sistent hepatitis was the predominant feature and 17 cases (31%) where there was chronic active hepatitis with piecemeal necrosis. Features which have previously been described in chronic HCV-associated hepatit is were noted: portal lymphoid aggregates (58%), lymphoid follicles wi th germinal centres (15%), bile duct damage (11%), lobular inflammatio n (80%), sinusoidal mononuclear cell infiltration (26%), acidophil bod y formation (11%), and steatosis (47%). Fibrosis was present in 46% of cases but was generally of mild degree; 9% of biopsies demonstrated b ridging fibrosis but no cases of cirrhosis were present. Even though s erum transaminase levels correlated well with the presence of chronic hepatitis and with the Scheuer and Knodell activity indices, a proport ion of patients with significant liver damage had normal transaminase levels, and this study suggests the need for liver biopsy in the evalu ation of asymptomatic HCV-positive blood donors.