Unrecognized hepatitis B in pre-screened children with hematologic and oncologic conditions

Pediatr Blood Cancer. 2014 May;61(5):865-8. doi: 10.1002/pbc.24853. Epub 2013 Nov 19.


Background: This study evaluates the effectiveness and interpretation of hepatitis B (HBV) screening in an at-risk cohort of children with cancer or blood disorders.

Procedure: We conducted a retrospective epidemiologic analysis of children who screened positive for HBV (HBsAg, HbcAb) from 1999 to 2009 at a quaternary children's hospital, focusing on patients with hematologic and oncologic conditions. Descriptive statistics were generated for demographics and serologies. Follow-up of positive serologies and clinical outcomes were analyzed.

Results: A total of 12,754 children were screened for HBV. Of 391 that screened positive, 118 had a hematologic or oncologic diagnosis. Leukemia, anemia, and thrombocytopenia comprised 84% of diagnoses. The majority (98%) tested HBcAb positive but only 20% received confirmatory HBV DNA testing. Three patients (13% of those HBV DNA tested) were identified to have chronic disease. HBV was not a known pre-existing condition, and chemotherapy preceded HBV diagnosis in all cases.

Conclusions: The majority of children with cancer or blood disorders who screened HBV positive did not receive follow-up DNA testing, exposing them to reactivation risk and delaying definitive therapy. HBcAb may be the only indicator of chronic HBV infection and DNA confirmation should be routine. Our findings suggest a significant number of additional patients eligible for HBV treatment may have been identified with reflexive DNA testing.

Keywords: BMT; Hepatitis B; chemotherapy; pediatric hematology and oncology; screening; viral infection.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • DNA, Viral / blood
  • DNA, Viral / genetics
  • Female
  • Follow-Up Studies
  • Hematologic Diseases / diagnosis*
  • Hematologic Diseases / virology
  • Hepatitis B / diagnosis*
  • Hepatitis B / virology
  • Hepatitis B Antibodies / blood*
  • Hepatitis B Surface Antigens / blood*
  • Hepatitis B virus / genetics
  • Hepatitis B virus / pathogenicity*
  • Humans
  • Infant
  • Male
  • Mass Screening*
  • Neoplasms / diagnosis*
  • Neoplasms / virology
  • Prognosis
  • Retrospective Studies
  • Texas / epidemiology
  • Virus Activation


  • DNA, Viral
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens