RARE DETECTION OF HEPATITIS-B AND HEPATITIS-C VIRUS GENOMES BY POLYMERASE CHAIN-REACTION IN SERONEGATIVE DONORS WITH ELEVATED ALANINE AMINOTRANSFERASE

Background: Since screening for antibody to hepatitis C virus (HCV) wa s introduced in 1990, posttransfusion hepatitis has been reduced to ne arly background levels. This has led to reconsideration of the value o f testing donated blood for elevated alanine aminotransferase (ALT). T he contribution of ALT testing in detecting seronegative infection was evaluated by the performance of polymerase chain reaction (PGR) for h epatitis 8 virus (HBV) or HCV in plasma from ALT-elevated blood units. Study Design and Methods: Testing was performed on 375 units of plasm a, derived from an equivalent of 47,500 blood donations, with a highly sensitive hemi-nested PCR procedure. Using a triplet of primers direc ted at the conserved regions of HBV DNA and 5'-noncoding regions of HC V RNA, the hemi-nested PCR assay can reliably amplify 10 viral molecul es to levels detectable in ethidium bromide-stained agarose gels. Pool s of plasma from groups of four donors were screened with hemi-nested PCR. For any reactive pools, the plasma from individual donors was ret ested twice on different aliquots. Results: Two of 375 units, both wit h midrange ALT elevation, were repeatedly reactive in hemi-nested PCR (one each for HBV DNA and HCV RNA). However, samples from the two susp ect donors tested 9 and 5 months later revealed no seroconversion, ele vated ALT, or viral genomes in hemi-nested PCR. Conclusion:The lack of confirmed HBV or HCV infection in this study representing an estimate d 47,500 voluntary blood donations suggests that routine ALT testing f or further prevention of posttransfusion hepatitis after exclusion of HBV- and/or HCV-seropositive blood may be superfluous.