Post-transfusion hepatitis in a London hospital: results of a two-year prospective study

SUMMARYSeven hundred and sixty-eight patients were seen and tested at frequent intervals after transfusion of whole blood. Eight patients were judged to have developed icteric or anicteric post-transfusion viral hepatitis, an incidence of 1%. Five were icteric and four of these were hepatitis B antigen (HB Ag) positive; two of these four died. One of the fatal cases and one non-fatal HB Ag positive case had received HB Ag positive blood. Two other antigen-positive patients had received blood or plasma or both which had not been tested for antigen.Thirty-five patients showed conspicuous or sustained elevations of alanine transaminase without clinical features of hepatitis.Four were positive for HB Ag but had not received antigen positive blood.Two who had received antigen positive blood remained antigen negative, but one developed hepatitis B antibody (HB Ab).Two other patients were also transfused with plasma.Five had serological evidence of cytomegalovirus (CMV) infection accompanying the enzyme changes.One patient who had received HB Ag positive blood remained antigen-negative and showed no abnormalities.Five patients who became HB Ag positive, although they had been given antigen-negative blood, remained clinically and biochemically well.Cytomegalovirus primary infection or reactivation occurred in another 32 patients; five had isolated, transient enzyme rises, one other was associated with a drug-induced focal liver necrosis and 26 showed no enzyme changes. Epstein–Barr virus infections, one of which was associated with a transient upset of enzyme activity, were detected in five patients. There were no cases of post-perfusion syndrome.