Hepatitis B core antigen antibody as an indicator of a low grade carrier state for hepatitis B virus in a Saudi Arabian blood donor population

Transfus Sci. 1997 Mar;18(1):49-53. doi: 10.1016/s0955-3886(96)00076-8.


Blood donor screening for anti-hepatitis B core antigen (anti-HBc) was introduced as a surrogate marker of non-A, non-B hepatitis prior to the availability of a specific test for hepatitis C. In areas endemic for hepatitis B virus (HBV), such as Saudi Arabia, earlier studies indicated that up to 30% of blood donors might disqualify if screened for anti-HBc. The issue was readdressed in a study of 6035 consecutive first-time Saudi national blood donors in an attempt to identify a subgroup of anti-HBc positive donors who might be at high risk of being low grade carriers of HBV. An isolated anti-HBc of high titer in a donor with a low or absent anti-hepatitis B surface antigen (anti-HBsAg) was taken as an indicator of increased risk of a low grade carrier state. Using this algorithm, an additional 125 (2%) donors would disqualify. HBsAg immune complex assays and polymerase chain reaction of donor samples with an isolated anti-HBc identified two donors with immune complexes and two donors with HBV DNA. All four donor samples expressed over 90% neutralization in the anti-HBc supplementary testing, indicating high titer anti-HBc. These findings seem to support the suggested policy of donor exclusion based on the anti-HBc and anti-HBsAg serology as a means to eliminate low grade carriers of HBV in endemic areas without jeopardizing the blood supply.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Viral*
  • Blood Donors*
  • Hepatitis B / diagnosis
  • Hepatitis B / epidemiology
  • Hepatitis B / etiology
  • Hepatitis B / prevention & control*
  • Hepatitis B Core Antigens / immunology*
  • Hepatitis B virus / immunology
  • Hepatitis B virus / isolation & purification*
  • Humans
  • Male
  • Mass Screening
  • Saudi Arabia / epidemiology
  • Transfusion Reaction*


  • Antibodies, Viral
  • Hepatitis B Core Antigens