Hepatitis B Viral Markers in Surface Antigen Negative Blood Donors: The Need to Look Beyond Antibody Negativity

BACKGROUND: The presence of Hepatitis B Virus (HBV) in blood that is Hepatitis B Surface Antigen (HBsAg) negative is considered a potential risk for transmission of hepatitis B virus infection. OBJECTIVE: To determine prevalence of antibodies to markers of hepatitis B virus infection in HBsAg negative prospective blood donors. METHODS: A structured questionnaire to assess prospective donor’s demographic data and past medical history was administered to 457 consenting HBsAg negative subjects. All the subjects were also negative for antibodies to hepatitis C virus (HCV), human immunodeficiency virus (HIV) and syphilis. Their serum samples were tested for the presence of anti-HBc, anti-HBe, anti-HBs and HBeAg. RESULTS: Of the 457 samples tested, 20 (4.37%), 58 (12.69%), 1 (0.22%), and 1 (0.22%) were positive to anti- HBc, anti-HBs, anti-HBe, and HBeAg antibodies, respectively. Ten (50%) of those who were positive for HBc antibody were also positive to anti-HBe and anti-HBs. Similarly, two (3.4%) donors who were positive for anti-HBs were also positive for HBeAg and anti-HBe. Of the 20 who were anti-HBc positive, seven had tattoo/traditional marks on their body and one had previous history of blood transfusion. CONCLUSION: This study has shown that some potential blood units containing HBV are being transfused to patients unknowingly by screening for HBsAg only. Screening for other markers of hepatitis B virus may increase the rejection rate, but will reduce HBV transmission.