Blood Res 2022; 57(2):
Published online June 30, 2022
https://doi.org/10.5045/br.2022.2021219
© The Korean Society of Hematology
Correspondence to : Novie Amelia Chozie, M.D., Ph.D.
Department of Child Health, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No.71, Salemba, Jakarta Pusat 10430, Indonesia
E-mail: novie.amelia@ui.ac.id
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background
Children with bleeding disorders, such as hemophilia and von Willebrand disease (VWD), have an increased risk of acquiring transfusion-transmitted infections (TTI). Screening methods to exclude blood donations that are at risk of transmitting infection from donors to recipients are critical to preventing disease transmission. Nucleic acid testing (NAT) is the latest blood donor-screening method. This study aimed to determine the incidence of hepatitis C virus (HCV) infection in children with hemophilia and VWD at Dr. Cipto Mangunkusumo Hospital with a history of blood transfusion before and after implementation of a NAT screening method.
Methods
A cohort retrospective study was conducted on children aged 0–18 years with bleeding disorders and a history of blood transfusion. In our center, all blood transfusions before 2015 were screened using non-NAT methods, while all blood transfusions were screened using NAT starting in 2015. Eligible patient characteristics were collected from medical records. From July to December 2019, blood samples were obtained from eligible patients for anti-HCV examination. HCV RNA examinations were performed on subjects with reactive anti-HCV results, and the relative risk was calculated.
Results
In total, 108 eligible participants were included in this study. We observed that 91 (94.3%) patients had history of receiving non-NAT blood transfusions, while 17 (15.7%) patients received NAT-screened blood transfusions. The proportion of anti-HCV reactivity in the non-NAT group and that in the NAT group were 3.3% (3/91) and 0% (0/17), respectively.
Conclusion
None of the patients exhibited reactivity to anti-HCV after implementing the NAT screening method.
Keywords Hemophilia, Von Willebrand, Hepatitis C infection, Blood transfusion, Nucleic acid testing
Blood Res 2022; 57(2): 129-134
Published online June 30, 2022 https://doi.org/10.5045/br.2022.2021219
Copyright © The Korean Society of Hematology.
Novie Amelia Chozie1, Melati Arum Satiti1, Damayanti Rusli Sjarif1, Hanifah Oswari1, Ni Ken Ritchie2
1Department of Child Health, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, 2Jakarta Blood Center, Indonesian Red Cross Society, Jakarta Pusat, Indonesia
Correspondence to:Novie Amelia Chozie, M.D., Ph.D.
Department of Child Health, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No.71, Salemba, Jakarta Pusat 10430, Indonesia
E-mail: novie.amelia@ui.ac.id
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background
Children with bleeding disorders, such as hemophilia and von Willebrand disease (VWD), have an increased risk of acquiring transfusion-transmitted infections (TTI). Screening methods to exclude blood donations that are at risk of transmitting infection from donors to recipients are critical to preventing disease transmission. Nucleic acid testing (NAT) is the latest blood donor-screening method. This study aimed to determine the incidence of hepatitis C virus (HCV) infection in children with hemophilia and VWD at Dr. Cipto Mangunkusumo Hospital with a history of blood transfusion before and after implementation of a NAT screening method.
Methods
A cohort retrospective study was conducted on children aged 0–18 years with bleeding disorders and a history of blood transfusion. In our center, all blood transfusions before 2015 were screened using non-NAT methods, while all blood transfusions were screened using NAT starting in 2015. Eligible patient characteristics were collected from medical records. From July to December 2019, blood samples were obtained from eligible patients for anti-HCV examination. HCV RNA examinations were performed on subjects with reactive anti-HCV results, and the relative risk was calculated.
Results
In total, 108 eligible participants were included in this study. We observed that 91 (94.3%) patients had history of receiving non-NAT blood transfusions, while 17 (15.7%) patients received NAT-screened blood transfusions. The proportion of anti-HCV reactivity in the non-NAT group and that in the NAT group were 3.3% (3/91) and 0% (0/17), respectively.
Conclusion
None of the patients exhibited reactivity to anti-HCV after implementing the NAT screening method.
Keywords: Hemophilia, Von Willebrand, Hepatitis C infection, Blood transfusion, Nucleic acid testing
Table 1 . Summary of the characteristics of the subjects..
Group 1 (NAT), N=17 (16%) | Group 2 (Non-NAT), N=91 (84%) | |
---|---|---|
Gender | ||
Male | 17 (100%) | 88 (97%) |
Female | 0 (0%) | 3 (3%) |
Age | ||
<2 years old | 0 (0%) | 0 (0%) |
2–15 years old | 14 (82%) | 72 (79%) |
≥16 years old | 3 (18%) | 19 (21%) |
Diagnosis | ||
Hemophilia A | 12 (71%) | 68 (75%) |
Hemophilia B | 5 (29%) | 22 (24%) |
Von Willebrand | 0 (0%) | 1 (1%) |
Severity | ||
Severe hemophilia | 11 (65%) | 54 (59%) |
Moderate hemophilia | 6 (35%) | 30 (33%) |
Mild hemophilia | 0 (0%) | 6 (7%) |
VWD type 1 | 0 (0%) | 1 (1%) |
Inhibitor FVIII | ||
Low titer | 0 (0%) | 1 (1%) |
High titer | 0 (0%) | 3 (3.3%) |
Negative | 16 (94%) | 85 (93.4%) |
History of inhibitor | 1 (6%) | 2 (2.2%) |
Number of bagsa) during transfusion | ||
1–4 bags | 9 (53%) | 42 (46%) |
5–10 bags | 6 (35%) | 36 (40%) |
>10 bags (volume of each bag ±50–180 mL) | 2 (12%) | 13 (14%) |
Age of first transfusion | ||
<2 years old | 6 (35%) | 34 (37%) |
2–15 years old | 11 (65%) | 57 (63%) |
≥16 years old | 0 (0%) | 0 (0%) |
Major surgery | ||
Yes | 0 (0%) | 18 (20%) |
No | 17 (100%) | 73 (80%) |
a)Any type of blood component product..
Abbreviations: NAT, nucleic acid testing; VWD, Von Willebrand disease..
Table 2 . Association between using NAT and the anti-HCV result..
Anti-HCV | Total | RR (95% CI) | |||
---|---|---|---|---|---|
Reactive, % | Non-reactive, % | ||||
NAT | 0 (0) | 17 (100) | 17 | 0.448 | 1.034 (0.996–1.074) |
Non-NAT | 3 (3.3) | 88 (96.7) | 91 |
Abbreviations: CI, confidence interval; HCV, hepatitis C virus; NAT, nucleic acid testing; RR, relative risk..
Table 3 . Summary of the characteristics of thesubjects with reactive anti-HCV..
Subject information | Subject A | Subject B | Subject C |
---|---|---|---|
Blood examination | |||
a. Anti HCV | Reactive | Reactive | Reactive |
b. HCV RNA | Virus not found | Virus not found | Virus not found |
Characteristics | |||
a. Gender | Male | Male | Male |
b. Age | 16 y.o. | 11 y.o. | 10 y.o. |
c. Diagnosis | Hemophilia A | Hemophilia A | Hemophilia B |
d. Severity | Severe | Moderate | Moderate |
e. Inhibitor | Negative | Negative | Negative |
f. History of major surgery | None | None | None |
g. First transfusion (yr/age) | 2009/6 y.o. | 2010/2 y.o. | 2012/3 y.o. |
h. Number of bags per transfusion (volume each bag ±50–180 mL) | 5–10 bags | 1–3 bags | 1–4 bags |
i. Blood screening method | ChLIA | ChLIA | ChLIA |
Abbreviations: ChLIA, chemoluminescence immunoassay; y.o., years old..
Debadrita Ray, Narender Kumar, Chander Hans, Anita Kler, Richa Jain, Deepak Bansal, Amita Trehan, Arihant Jain, Pankaj Malhotra, Jasmina Ahluwalia
Blood Res 2023; 58(1): 61-70Davod Javanmard, Masood Ziaee, Hadi Ghaffari, Mohammad Hasan Namaei, Ahmad Tavakoli, Hamidreza Mollaei, Mohsen Moghoofei, Helya Sadat Mortazavi, and Seyed Hamidreza Monavari
Blood Res 2017; 52(4): 311-315Ja Young Seo, Mi-Ae Jang, Hee-Jung Kim, Ki-O Lee, Sun-Hee Kim, and Hee-Jin Kim
Blood Res 2013; 48(3): 206-210