International review of blood donation screening for anti-HBc and occult hepatitis B virus infection

Transfusion. 2024 Nov;64(11):2144-2156. doi: 10.1111/trf.18018. Epub 2024 Oct 2.

Abstract

Background: Hepatitis B core antibody (anti-HBc) screening has been implemented in many blood establishments to help prevent transmission of hepatitis B virus (HBV), including from donors with occult HBV infection (OBI). We review HBV screening algorithms across blood establishments globally and their potential effectiveness in reducing transmission risk.

Materials and methods: A questionnaire on HBV screening and follow-up strategies was distributed to members of the International Society of Blood Transfusion working party on transfusion-transmitted infectious diseases. Screening data from 2022 were assimilated and analyzed.

Results: A total of 30 unique responses were received from 25 countries. Sixteen respondents screened all donations for anti-HBc, with 14 also screening all donations for HBV DNA. Anti-HBc prevalence was 0.42% in all blood donors and 1.19% in new donors in low-endemic countries; however, only 44% of respondents performed additional anti-HBc testing to exclude false reactivity. 0.68% of anti-HBc positive, HBsAg-negative donors had detectable HBV DNA. Ten respondents did universal HBV DNA screening without anti-HBc, whereas four respondents did not screen for either. Deferral strategies for anti-HBc positive donors were highly variable. One transfusion-transmission from an anti-HBc negative donor was reported.

Discussion: Anti-HBc screening identifies donors with OBI but also results in the unnecessary deferral of a significant number of donors with resolved HBV infection and donors with false-reactive anti-HBc results. Whilst confirmation of anti-HBc results could be improved to reduce donor deferral, transmission risks associated with anti-HBc negative OBI donors must be considered. In high-endemic areas, highly sensitive HBV DNA testing is required to identify infectious donors.

Keywords: HBV screening; NAT; anti‐HBc testing; blood transfusion; safety.

Publication types

  • Review

MeSH terms

  • Blood Donation
  • Blood Donors*
  • DNA, Viral* / blood
  • Donor Selection* / methods
  • Female
  • Hepatitis B Antibodies* / blood
  • Hepatitis B Core Antigens / blood
  • Hepatitis B Core Antigens / immunology
  • Hepatitis B virus* / immunology
  • Hepatitis B virus* / isolation & purification
  • Hepatitis B* / blood
  • Hepatitis B* / diagnosis
  • Hepatitis B* / epidemiology
  • Hepatitis B* / prevention & control
  • Hepatitis B* / transmission
  • Humans
  • Male
  • Mass Screening / methods
  • Surveys and Questionnaires

Substances

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