Irving, W L

James, V

Neal, K R

Simmonds, P N

Underwood, J C E

English

Edinburgh Research Explorer

     Edinburgh Research Explorer                                      Chronic hepatitis in United Kingdom blood donors infected withhepatitis C virusCitation for published version:Irving, WL, Neal, KR, Underwood, JCE, Simmonds, PN & James, V 1994, 'Chronic hepatitis in UnitedKingdom blood donors infected with hepatitis C virus' BMJ, vol 308, no. 6930, pp. 695-696.,10.1136/bmj.308.6930.695Digital Object Identifier (DOI):10.1136/bmj.308.6930.695Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher final version (usually the publisher pdf)Published In:BMJGeneral rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 20. Feb. 2015Reciprocal regulatory effects of IFN-gamma and ILA4 on the in vitrodevelopment ofhuman THI and TH2 clones.IImmunol 1992;148:2142-7.13 Komlos L, Landmann J, Notnann J, Dulitzky F, Kyzer S, Hart J, et al. Sialicacid level in maternal and neonatal lymphocytes and sera correlated to birthorder and sex ofthe neonate. Biol Neonate 1992;62:379-84.14 Shearer WT, Gottlieb C, Kornfeld S. Humoral imnuunostimulation. VII.Sialic acid masks antigenic sites on antibody-selected variant cell line.Jlmmsunol 1977;119:614-7.15 Varonier HS, de Hailer J, Schopfer C. [Prevalence of allergies in children andadolescents.] Helv PaediatrActa 1984;39:129-36. (In French.)16 Fleming DM, Crombie DL. Prevalence of asthma and hay fever in Englandand Wales. BM_ 1987;294:279-83.17 Ninan T, Russell G. Respiratory symptoms and atopy in Aberdeen school-children: evidence from two surveys 25 years apart. BMJ 1992;304:873-5.18 W0thrich B, Schneyder UW, Henaue SA, Heller A. [Incidence of pollinosisin Switzerland. Results of a representative demographic survey withconsideration of other allergic disorders.] Schweiz Med Wochenschr 1986;116:909-17. (In German.)19 Taylor B, Wadsworth J, Wadsworth M, Peckham C. Changes in the reportedprevalence of childhood eczema since the 1939-45 war. Lancet 1984;i:1255-7.(Accepted 16 November 1993)University Hospital,Queen's Medical Centre,Nottingham NG7 2UHW L Irving, senior lecturer inclinical virologyK R Neal, lecturer in publichealth medicine andepidemiologyRoyal HaflamshireHospital, Sheffield S10 2JFJ C E Underwood, professorofpathologyMedical School, UniversityofEdinburgh, EdinburghEH8 9AGP N Simmonds, lecturer inmedical microbiologyTrent Regional BloodTransfusion Centre,Sheffield S5 7JNV James, consultanthaematologistOther members of the TrentRegional Hepatitis C VirusStudy Group are listed at theend of the paper.Correspondence to:Dr Irving.BMJ 1994;308:695-6Chronic hepatitis in UnitedKingdom blood donors infectedwith hepatitds C virusW L Irving, KR Neal, J C E Underwood,P N Simmonds, V James, on behalf ofTrentRegional Hepatitis C Virus Study GroupRoutine screening for antibodies to hepatitis C virus inblood donations was introduced in Britain in 1991. Itshowed that 1 in 2000 donors was positive for anti-bodies. The natural course and importance of hepatitisC virus infection in apparently healthy people areunclear. We assessed the value of clinical and labora-tory data in predicting the need for liver biopsy inblood donors with antibodies to hepatitis C virus.Patients, methods, and resultsBlood donors in the Trent region are screened forantibodies to hepatitis C virus by second generationenzyme linked immunosorbent assay, and results areconfirmed by a four antigen recombinant immunoblotassay. Donors with positive results are interviewed andreferred to a consultant for further management. Westudied all 52 donors who had had a liver biopsy by1 May 1993 (30 men, 22 women; aged 21-57 (mean 35)years).We collected data on risk factors for hepatitis C virusinfection, duration of infection (assuming that infectionwas acquired on the first exposure to a risk factor),and alcohol intake. Alanine aminotransferase con-centrations (three measurements), GOR antibodies,'hepatitis C virus RNA,' and hepatitis C virus serotype3were measured. Biopsy specimens were scored blindby the Knodell and Sheffield4 schemes; the Sheffieldscheme includes assessment of histological featurescharacteristic of hepatitis C. We used the statisticalpackage spss-pc to analyse data with Spearman rankcorrelation, Mann-Whitney, and logistic regressionanalyses. Predictive values for severe liver disease(chronic active hepatitis or cirrhosis) were calculatedby using the standard definition and 95% confidenceintervals by the program Confidence Interval Analysis.The histological diagnoses were cirrhosis (fourpatients), chronic active hepatitis (13), chronicpersistent hepatitis (32), fatty change (one), andnormal (two). Hepatitis C virus RNA was detected insera from 51 donors. The biopsy specimen from thedonor without viral RNA was normal. Hepatitis Cvirus RNA was assayed twice in 31 donors: 28 hadpositive results in both samples, one had negativeresults in both, and two had a positive result in the firstsample but a negative second result. The biopsyspecimens from the donors with discordant resultswere reported as normal in one and chronic persistenthepatitis with features of al antitrypsin deficiency inthe other. A negative test result was significantly associ-ated with lower severity scores for biopsy specimens(Knodell score P=0-006; Sheffield score P=0 005).Peak alanine aminotransferase concentration wascorrelated with both severity scores (Knodell scorer8=0 59, P<0-001; Sheffield score r,=0 66, p<0-001,figure). The predictive value for chronic active hepatitisor cirrhosis was 0-42 (13/31 donors, 95% confidenceinterval 0-25 to 0-61) for an alanine aminotransferaseconcentration above 60 IU/l and 0 47 (9/19, 0-24 to07 1) for a concentration above 100 IU/l. The predictivevalue of an alanine aminotransferase concentrationunder 60 IU/l for chronic persistent hepatitis, fattychange, or a normal biopsy result was 0-81 (17/21, 0-58to 0 95).Liver damage was more severe in men than women(median Knodell score 4 v 2, P= 0 03; Sheffield score 5v 3, P=0.02). Logistic regression models found noother significant predictor for histological change.1412 oo] o0 10( 8 oa 6 o_oi,U UX 4 A1AA A _o_El _2 _ __2_ _0 100 200 300 400Alanine aminotransferase (IU/l)Correlation between Sheffield score of severity of disease in liver biopsyspecimen andpeak alanine aminotransferase concentration.AChronic hepatitis or normal, *=cirrhosis, [=chronic activehepatitisCommentFifty of 52 biopsy specimens from apparently healthyblood donors infected with hepatitis C virus wereabnormal, with a third having evidence of chronicactive hepatitis or cirrhosis. Although peak alanineaminotransferase concentration and biopsy scoreswere strongly correlated, alanine aminotransferaseconcentration was a poor predictor of serious liverdisease.Possible explanations for the discordant results withthe test for hepatitis C virus RNA include intermittentviraemia,5 low level viraemia, false positive or negativeresults, and clearance of viraemia between sampling.Larger studies are needed to determine whethervariable results for viral RNA are associated with lesssevere liver disease.We found no useful predictors of the severity of liverdisease. Our estimates of age at, and duration of,infection, however, had obvious limitations. Our datasuggest that donors who have repeated positive resultsfor hepatitis C virus RNA require liver biopsy as a largeproportion will have serious liver disease that cannotbe predicted by measuring alanine aminotransferaseconcentration.Members of the Trent Regional Hepatitis C Virus StudyGroup were D A Jones, P Nuttall (Trent Regional BloodTransfusion Service); S Day (Nottingham University); DBMJ VOLUME 308 12MARCH1994 695Bennett, R P Eglin (Leeds Public Health Laboratory); R GFinch, R Read (Nottingham City Hospital); M McKendrick,D R Triger, D Williams (Royal Hallamshire Hospital,Sheffield); B B Scott (Lincoln County Hospital); K GNicholson, M Wiselka (Leicester Royal Infirmary); JFreeman (Derby Royal Infinnary), and K Rose (Departmentof Microbiology, University ofEdinburgh).1 Irving WL, Day S, Bennett D, Eglin RP, Flanagan P, Nuttall P, et al. The use ofanti-GOR testing in the screening of blood donors for hepatitis C virusinfection. Vox Sang 1993;65:38-41.2 Garson JA, Ring CJA, Tuke PW. Improvement ofHCV genome detection with"short" PCRproducts. Lancet 1991;338:1466-7.3 SimmondsP, Rose K, GrahamS, ChanS-W,McOnishF, DowBC, etal. Mappingof serotype-specific, immunodominant epitopes in the NS-4 region of hepa-titis C virus: use of type-specific peptides to serologically differentiate infectionwith HCV types 1, 2 and 3.JClin Microbiol 1993;31:1493-503.4 Makris M, Preston FE, Triger DR, Underwood JCE, Westlake L, AdelmanMI. Randomised controlled trial of recombinant interferon-alpha in chronichepatitis C in haemophiliacs. Blood 1991;78:1672-7.5 Alter MI, Margolis HS, Krawczynski K, Judson FN, Males A, Alexander WI,et al. The natural history of community-acquired hepatitis C in the UnitedStates. NEnglJ7Med 1992;327:1899-905.(Accepted 17 February 1994)North London BloodTransfusion Centre,Colindale, LondonNW9 5BGKate E Ryan, senior registrarSheila MacLennan, seniorregistrarJAJ Barbara, head ofmicrobiologyPatricia E Hewitt, deputymedical directorCorrespondence to:Dr Hewitt.BMY 1994;308:696-7Foliow up ofblood donorspositive for antibodies tohepatitis C virusKate E Ryan, Sheila MacLennan, J A J Barbara,Patricia E HewittThe hepatitis C virus has been identified as the maincause of post-transfusion hepatitis.' Mandatory screen-ing of blood donations for antibodies to hepatitis Cvirus was introduced by the National Blood Trans-fusion Service on 1 September 1991. Donors con-firmed to be positive for antibodies to hepatitis C virusat the North London Blood Transfusion Centre areoffered counselling by medical staff at the centre, whoexplain the relevance of the test results. They are thenreferred to their general practitioner.Current evidence suggests that many of theasymptomatic donors positive for antibodies to hepa-titis C virus are chronic carriers, in whom the virusreplicates.2 Probably some asymptomatic donors willprogress to clinically significant, and possibly severe,liver disease in the future. Follow up of the donor bythe general practitioner or hospital clinic, or both, willbe influenced by information and advice given as aresult of the initial counselling. To date there has beenDonors counselled at transfusion centre70Consulted general practitioner Failed to consult general practitioner57 1 3Consulted over Hepatitis C virus results not discussedhepatitis C virus result by donor or general practitioner54 3Referred to specialist centre Not referred Unknown reasons42 12 2Abnormal Normalliver function liver function l Normal26 _ 6Unwilling liver function26 16Seen by specialist Not yet seen36 6Liver biopsy Uver biopsy Noperformed planned liver biopsy6 525Histological picture* Mild inflammatory change 2 0 Chronic active hepatitis (mild) I* Chronic persistent hepatitis I 0 Results not available 2Flow chart showing management ofanti-HCVpositive blood donorsno information on the effectiveness of the counsellingprocedure and the fate of donors after leaving thetransfusion centre. We carried out a postal survey onthe follow up arrangements for blood donors positivefor antibodies to hepatitis C virus.Subjects, methods, and resultsA postal questionnaire was sent to 83 of 107 blooddonors positive for antibodies to hepatitis C virus whohad been identified and counselled at the NorthLondon Blood Transfusion Centre until the end ofJune1992. The remaining donors were excluded eitherbecause they had failed to attend for counselling (16donors) or because they were uncontactable (eightdonors). A questionnaire was then sent to the doctors of80 of these donors (two donors withheld consent andin one case the general practitioner was unknown).Replies were received from 50 donors and 61 generalpractitioners (response rates 60% and 76% respec-tively). Taken together, the questionnaire responsesgave information on 70 donors. Presentation of thedonor to the general practitioner and subsequentmanagement by the general practitioner are shown inthe flow chart. The demographic details and possiblesources of infection of these donors have been analysedseparately.3Most ofthe donors positive for antibodies to hepatitisC virus were referred for specialist opinion irrespectiveof whether their liver function was reported asabnormal by the transfusion centre. Of the 12 donorsnot referred, four either refused or failed to attendfollow up appointments with the general practitionerand six had normal liver function values; lack ofreferralwas in accordance with the centre's guidelines at thetime. Liver biopsy was performed or pending in 11cases. One donor had been considered for treatmentwith interferon alfa after the biopsy result.The partners (all heterosexual) of 27 donors weretested. None of 14 male partners and one of 13 femalepartners was found to be infected, but details ofpossible shared risk factors for this partner were notavailable. Overall, general practitioners and donorsindicated satisfaction with the counselling service atthe transfusion centre. The main concems expressedby donors were implications for sexual partners and forfuture offspring.CommentThe positivity rate positive for antibodies to hepatitisC virus among first time donors at the North LondonBlood Transfusion Centre is one in 1400. Based onthese figures, we should anticipate that 30 suchasymptomatic subjects would be identified annually atthe centre once the established donor panel had beenscreened.This survey shows that, after counselling, 13 of 70donors did not consult their general practitioner abouttheir hepatitis C virus result. Of those who do,however, most are being referred to a specialist clinic696 BMJ VOLUME 308 12 MARCH 1994

Chronic hepatitis in United Kingdom blood donors infected with hepatitis C virus

W L Irving

K R Neal

J C E Underwood

P N Simmonds

V James

Crossref

     Edinburgh Research Explorer                                      Chronic hepatitis in United Kingdom blood donors infected withhepatitis C virusCitation for published version:Irving, WL, Neal, KR, Underwood, JCE, Simmonds, PN & James, V 1994, 'Chronic hepatitis in UnitedKingdom blood donors infected with hepatitis C virus', British Medical Journal (BMJ), vol. 308, no. 6930, pp.695-696. https://doi.org/10.1136/bmj.308.6930.695Digital Object Identifier (DOI):10.1136/bmj.308.6930.695Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordPublished In:British Medical Journal (BMJ)General rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 29. Nov. 2025Reciprocal regulatory effects of IFN-gamma and ILA4 on the in vitrodevelopment ofhuman THI and TH2 clones.IImmunol 1992;148:2142-7.13 Komlos L, Landmann J, Notnann J, Dulitzky F, Kyzer S, Hart J, et al. Sialicacid level in maternal and neonatal lymphocytes and sera correlated to birthorder and sex ofthe neonate. Biol Neonate 1992;62:379-84.14 Shearer WT, Gottlieb C, Kornfeld S. Humoral imnuunostimulation. VII.Sialic acid masks antigenic sites on antibody-selected variant cell line.Jlmmsunol 1977;119:614-7.15 Varonier HS, de Hailer J, Schopfer C. [Prevalence of allergies in children andadolescents.] Helv PaediatrActa 1984;39:129-36. (In French.)16 Fleming DM, Crombie DL. Prevalence of asthma and hay fever in Englandand Wales. BM_ 1987;294:279-83.17 Ninan T, Russell G. Respiratory symptoms and atopy in Aberdeen school-children: evidence from two surveys 25 years apart. BMJ 1992;304:873-5.18 W0thrich B, Schneyder UW, Henaue SA, Heller A. [Incidence of pollinosisin Switzerland. Results of a representative demographic survey withconsideration of other allergic disorders.] Schweiz Med Wochenschr 1986;116:909-17. (In German.)19 Taylor B, Wadsworth J, Wadsworth M, Peckham C. Changes in the reportedprevalence of childhood eczema since the 1939-45 war. Lancet 1984;i:1255-7.(Accepted 16 November 1993)University Hospital,Queen's Medical Centre,Nottingham NG7 2UHW L Irving, senior lecturer inclinical virologyK R Neal, lecturer in publichealth medicine andepidemiologyRoyal HaflamshireHospital, Sheffield S10 2JFJ C E Underwood, professorofpathologyMedical School, UniversityofEdinburgh, EdinburghEH8 9AGP N Simmonds, lecturer inmedical microbiologyTrent Regional BloodTransfusion Centre,Sheffield S5 7JNV James, consultanthaematologistOther members of the TrentRegional Hepatitis C VirusStudy Group are listed at theend of the paper.Correspondence to:Dr Irving.BMJ 1994;308:695-6Chronic hepatitis in UnitedKingdom blood donors infectedwith hepatitds C virusW L Irving, KR Neal, J C E Underwood,P N Simmonds, V James, on behalf ofTrentRegional Hepatitis C Virus Study GroupRoutine screening for antibodies to hepatitis C virus inblood donations was introduced in Britain in 1991. Itshowed that 1 in 2000 donors was positive for anti-bodies. The natural course and importance of hepatitisC virus infection in apparently healthy people areunclear. We assessed the value of clinical and labora-tory data in predicting the need for liver biopsy inblood donors with antibodies to hepatitis C virus.Patients, methods, and resultsBlood donors in the Trent region are screened forantibodies to hepatitis C virus by second generationenzyme linked immunosorbent assay, and results areconfirmed by a four antigen recombinant immunoblotassay. Donors with positive results are interviewed andreferred to a consultant for further management. Westudied all 52 donors who had had a liver biopsy by1 May 1993 (30 men, 22 women; aged 21-57 (mean 35)years).We collected data on risk factors for hepatitis C virusinfection, duration of infection (assuming that infectionwas acquired on the first exposure to a risk factor),and alcohol intake. Alanine aminotransferase con-centrations (three measurements), GOR antibodies,'hepatitis C virus RNA,' and hepatitis C virus serotype3were measured. Biopsy specimens were scored blindby the Knodell and Sheffield4 schemes; the Sheffieldscheme includes assessment of histological featurescharacteristic of hepatitis C. We used the statisticalpackage spss-pc to analyse data with Spearman rankcorrelation, Mann-Whitney, and logistic regressionanalyses. Predictive values for severe liver disease(chronic active hepatitis or cirrhosis) were calculatedby using the standard definition and 95% confidenceintervals by the program Confidence Interval Analysis.The histological diagnoses were cirrhosis (fourpatients), chronic active hepatitis (13), chronicpersistent hepatitis (32), fatty change (one), andnormal (two). Hepatitis C virus RNA was detected insera from 51 donors. The biopsy specimen from thedonor without viral RNA was normal. Hepatitis Cvirus RNA was assayed twice in 31 donors: 28 hadpositive results in both samples, one had negativeresults in both, and two had a positive result in the firstsample but a negative second result. The biopsyspecimens from the donors with discordant resultswere reported as normal in one and chronic persistenthepatitis with features of al antitrypsin deficiency inthe other. A negative test result was significantly associ-ated with lower severity scores for biopsy specimens(Knodell score P=0-006; Sheffield score P=0 005).Peak alanine aminotransferase concentration wascorrelated with both severity scores (Knodell scorer8=0 59, P<0-001; Sheffield score r,=0 66, p<0-001,figure). The predictive value for chronic active hepatitisor cirrhosis was 0-42 (13/31 donors, 95% confidenceinterval 0-25 to 0-61) for an alanine aminotransferaseconcentration above 60 IU/l and 0 47 (9/19, 0-24 to07 1) for a concentration above 100 IU/l. The predictivevalue of an alanine aminotransferase concentrationunder 60 IU/l for chronic persistent hepatitis, fattychange, or a normal biopsy result was 0-81 (17/21, 0-58to 0 95).Liver damage was more severe in men than women(median Knodell score 4 v 2, P= 0 03; Sheffield score 5v 3, P=0.02). Logistic regression models found noother significant predictor for histological change.1412 oo] o0 10( 8 oa 6 o_oi,U UX 4 A1AA A _o_El _2 _ __2_ _0 100 200 300 400Alanine aminotransferase (IU/l)Correlation between Sheffield score of severity of disease in liver biopsyspecimen andpeak alanine aminotransferase concentration.AChronic hepatitis or normal, *=cirrhosis, [=chronic activehepatitisCommentFifty of 52 biopsy specimens from apparently healthyblood donors infected with hepatitis C virus wereabnormal, with a third having evidence of chronicactive hepatitis or cirrhosis. Although peak alanineaminotransferase concentration and biopsy scoreswere strongly correlated, alanine aminotransferaseconcentration was a poor predictor of serious liverdisease.Possible explanations for the discordant results withthe test for hepatitis C virus RNA include intermittentviraemia,5 low level viraemia, false positive or negativeresults, and clearance of viraemia between sampling.Larger studies are needed to determine whethervariable results for viral RNA are associated with lesssevere liver disease.We found no useful predictors of the severity of liverdisease. Our estimates of age at, and duration of,infection, however, had obvious limitations. Our datasuggest that donors who have repeated positive resultsfor hepatitis C virus RNA require liver biopsy as a largeproportion will have serious liver disease that cannotbe predicted by measuring alanine aminotransferaseconcentration.Members of the Trent Regional Hepatitis C Virus StudyGroup were D A Jones, P Nuttall (Trent Regional BloodTransfusion Service); S Day (Nottingham University); DBMJ VOLUME 308 12MARCH1994 695Bennett, R P Eglin (Leeds Public Health Laboratory); R GFinch, R Read (Nottingham City Hospital); M McKendrick,D R Triger, D Williams (Royal Hallamshire Hospital,Sheffield); B B Scott (Lincoln County Hospital); K GNicholson, M Wiselka (Leicester Royal Infirmary); JFreeman (Derby Royal Infinnary), and K Rose (Departmentof Microbiology, University ofEdinburgh).1 Irving WL, Day S, Bennett D, Eglin RP, Flanagan P, Nuttall P, et al. The use ofanti-GOR testing in the screening of blood donors for hepatitis C virusinfection. Vox Sang 1993;65:38-41.2 Garson JA, Ring CJA, Tuke PW. Improvement ofHCV genome detection with"short" PCRproducts. Lancet 1991;338:1466-7.3 SimmondsP, Rose K, GrahamS, ChanS-W,McOnishF, DowBC, etal. Mappingof serotype-specific, immunodominant epitopes in the NS-4 region of hepa-titis C virus: use of type-specific peptides to serologically differentiate infectionwith HCV types 1, 2 and 3.JClin Microbiol 1993;31:1493-503.4 Makris M, Preston FE, Triger DR, Underwood JCE, Westlake L, AdelmanMI. Randomised controlled trial of recombinant interferon-alpha in chronichepatitis C in haemophiliacs. Blood 1991;78:1672-7.5 Alter MI, Margolis HS, Krawczynski K, Judson FN, Males A, Alexander WI,et al. The natural history of community-acquired hepatitis C in the UnitedStates. NEnglJ7Med 1992;327:1899-905.(Accepted 17 February 1994)North London BloodTransfusion Centre,Colindale, LondonNW9 5BGKate E Ryan, senior registrarSheila MacLennan, seniorregistrarJAJ Barbara, head ofmicrobiologyPatricia E Hewitt, deputymedical directorCorrespondence to:Dr Hewitt.BMY 1994;308:696-7Foliow up ofblood donorspositive for antibodies tohepatitis C virusKate E Ryan, Sheila MacLennan, J A J Barbara,Patricia E HewittThe hepatitis C virus has been identified as the maincause of post-transfusion hepatitis.' Mandatory screen-ing of blood donations for antibodies to hepatitis Cvirus was introduced by the National Blood Trans-fusion Service on 1 September 1991. Donors con-firmed to be positive for antibodies to hepatitis C virusat the North London Blood Transfusion Centre areoffered counselling by medical staff at the centre, whoexplain the relevance of the test results. They are thenreferred to their general practitioner.Current evidence suggests that many of theasymptomatic donors positive for antibodies to hepa-titis C virus are chronic carriers, in whom the virusreplicates.2 Probably some asymptomatic donors willprogress to clinically significant, and possibly severe,liver disease in the future. Follow up of the donor bythe general practitioner or hospital clinic, or both, willbe influenced by information and advice given as aresult of the initial counselling. To date there has beenDonors counselled at transfusion centre70Consulted general practitioner Failed to consult general practitioner57 1 3Consulted over Hepatitis C virus results not discussedhepatitis C virus result by donor or general practitioner54 3Referred to specialist centre Not referred Unknown reasons42 12 2Abnormal Normalliver function liver function l Normal26 _ 6Unwilling liver function26 16Seen by specialist Not yet seen36 6Liver biopsy Uver biopsy Noperformed planned liver biopsy6 525Histological picture* Mild inflammatory change 2 0 Chronic active hepatitis (mild) I* Chronic persistent hepatitis I 0 Results not available 2Flow chart showing management ofanti-HCVpositive blood donorsno information on the effectiveness of the counsellingprocedure and the fate of donors after leaving thetransfusion centre. We carried out a postal survey onthe follow up arrangements for blood donors positivefor antibodies to hepatitis C virus.Subjects, methods, and resultsA postal questionnaire was sent to 83 of 107 blooddonors positive for antibodies to hepatitis C virus whohad been identified and counselled at the NorthLondon Blood Transfusion Centre until the end ofJune1992. The remaining donors were excluded eitherbecause they had failed to attend for counselling (16donors) or because they were uncontactable (eightdonors). A questionnaire was then sent to the doctors of80 of these donors (two donors withheld consent andin one case the general practitioner was unknown).Replies were received from 50 donors and 61 generalpractitioners (response rates 60% and 76% respec-tively). Taken together, the questionnaire responsesgave information on 70 donors. Presentation of thedonor to the general practitioner and subsequentmanagement by the general practitioner are shown inthe flow chart. The demographic details and possiblesources of infection of these donors have been analysedseparately.3Most ofthe donors positive for antibodies to hepatitisC virus were referred for specialist opinion irrespectiveof whether their liver function was reported asabnormal by the transfusion centre. Of the 12 donorsnot referred, four either refused or failed to attendfollow up appointments with the general practitionerand six had normal liver function values; lack ofreferralwas in accordance with the centre's guidelines at thetime. Liver biopsy was performed or pending in 11cases. One donor had been considered for treatmentwith interferon alfa after the biopsy result.The partners (all heterosexual) of 27 donors weretested. None of 14 male partners and one of 13 femalepartners was found to be infected, but details ofpossible shared risk factors for this partner were notavailable. Overall, general practitioners and donorsindicated satisfaction with the counselling service atthe transfusion centre. The main concems expressedby donors were implications for sexual partners and forfuture offspring.CommentThe positivity rate positive for antibodies to hepatitisC virus among first time donors at the North LondonBlood Transfusion Centre is one in 1400. Based onthese figures, we should anticipate that 30 suchasymptomatic subjects would be identified annually atthe centre once the established donor panel had beenscreened.This survey shows that, after counselling, 13 of 70donors did not consult their general practitioner abouttheir hepatitis C virus result. Of those who do,however, most are being referred to a specialist clinic696 BMJ VOLUME 308 12 MARCH 1994

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Chronic hepatitis in United Kingdom blood donors infected with hepatitis C virus

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