Hepatites pós-transfusionais na cidade de Campinas, SP, Brasil: II. Presença dos anticorpos anti-HBc e anti-HCV em candidatos a doadores de sangue e ocorrência de hepatites pós-transfusionais pelo vírus C nos receptores de sangue ou derivados

Gonçales Júnior, Fernando Lopes; Pedro, Rogério de Jesus; Silva, Luiz Jacintho da; Boccato, Raquel Silveira Bello Stucchi; Gonçales, Neiva Sellan Lopes

doi:10.1590/S0036-46651993000100009

Resumos

Pesquisamos os anticorpos anti-HBc e anti-HCV em amostras de soros provenientes de 799 candidatos a doadores, que tiveram suas unidades de sangue ou derivados transfundidas a 111 receptores. O anti-HBc e o anti-HCV foram reagentes, em respectivamente 9 e 2,1% dos doadores testados. Observamos que entre os 111 receptores, 44 haviam recebido pelo menos uma unidade anti-HBc positiva e 67 haviam sido transfundidos somente com unidades anti-HBc negativas. Houve um risco 4,5 vezes maior de aquisição de hepatite por vírus C pelos receptores que receberam pelo menos uma unidade anti-HBc positiva Se a pesquisa do anti-HBc fosse realizada na triagem sorológica dos doadores de sangue, cerca de 56% dos casos de HVC nos receptores saiam evitados. A população de receptores que recebeu pelo menos uma unidade anti-HCV reagente, apresentou um risco 29 vezes maior de adquirir esta hepatite, quando comparada aos receptores transfundidos com todas as unidades anti-HCV negativas. A realização do teste para a pesquisa do anti-HCV na triagem dos doadores de sangue, preveniria 79% dos casos de HVC pós-transfusionais. Os candidatos a doadores brasileiros parecem ser acometidos simultânea ou sequencialmente, pelos vírus B e C das hepatites, pois, 44,4% dos doadores anti-HCV positivos, também foram anti-HBc positivos. A realização dos testes para as pesquisas dos anticorpos anti-HBc e anti-HCV, nas triagens hemoterápicas, está indicada para prevenir a transmissão de hepatites pós-transfusionais, em nosso meio.

Hepatite por vírus C; Anti-HBc; Anti-HCV; Hepatites pós-transfusionais; Hepatite por vírus B

We have analysed anti-HBc and anti-HCV antibodies in serum samples from 799 donors which had their blood or derivates transfused to 111 recipients. Anti-HBc and anti-HCV were reactive in respectively 9 and 2.1% of the donors tested. We have observed that among the 111 recipients, 44 had received at least one positive anti-HBc unit and 67 had been transfused only with negative anti-HBc, units. The risk of developing hepatitis C virus was 4.5 times higher for the recipients who received at least one positive anti-HBc unit. If the test for anti-HBc had been made for the blood donors in the serological screening, about 56% of the HCV cases in the recipients could have been avoided. The population of recipients who received at least one reacting unit of anti-HCV, presented a risk 29 times higher of developing this hepatitis, as compared to the transfused recipients with all anti-HCV negative units. Testing blood from donors for anti-HCV would avoid 79% of the post-transfusional HCV cases. Brazilian candidates to blood donors seem to be carriers either simultaneously or sequentially to hepatitis virus B and C, since 44.4% of the positive anti-HCV were also positive for anti-HBc. Testing for anti-HBc and anti-HCV in blood screening must be indicated in order to prevent post-transfusional hepatitis transmission in our community.

EPIDEMIOLOGIA

Hepatites pós-transfusionais na cidade de Campinas, SP, Brasil. II. Presença dos anticorpos anti-HBc e anti-HCV em candidatos a doadores de sangue e ocorrência de hepatites pós-transfusionais pelo vírus C nos receptores de sangue ou derivados

Post-transfusional hepatitis in the city of Campinas, SP, Brazil. II- Presence of anti-HBc and anti-HCV antibodies in blood donors and occurrence of post-transfusional hepatitis C virus in recipients of blood or derivates

Fernando Lopes Gonçales Júnior^I; Rogério de Jesus Pedro^I; Luiz Jacintho da Silva^I; Raquel Silveira Bello Stucchi Boccato^I; Neiva Sellan Lopes Gonçales^II

^IDisciplina de Doenças Transmissíveis da Faculdade de Ciências Médicas - UNICAMP - Campinas, São Paulo, Brasil

^IIHemocentro-Campinas - UNICAMP - Campinas, São Paulo, Brasil

^{Endereço para correspondência} Endereço para correspondência: Prof. Dr. Fernando Lopes Gonçales Junior Disciplina de Doenças Transmissíveis da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP) Caixa Postal 1170 CEP 13081. Campinas, São Paulo, Brasil

RESUMO

Pesquisamos os anticorpos anti-HBc e anti-HCV em amostras de soros provenientes de 799 candidatos a doadores, que tiveram suas unidades de sangue ou derivados transfundidas a 111 receptores. O anti-HBc e o anti-HCV foram reagentes, em respectivamente 9 e 2,1% dos doadores testados.

Observamos que entre os 111 receptores, 44 haviam recebido pelo menos uma unidade anti-HBc positiva e 67 haviam sido transfundidos somente com unidades anti-HBc negativas. Houve um risco 4,5 vezes maior de aquisição de hepatite por vírus C pelos receptores que receberam pelo menos uma unidade anti-HBc positiva Se a pesquisa do anti-HBc fosse realizada na triagem sorológica dos doadores de sangue, cerca de 56% dos casos de HVC nos receptores saiam evitados.

A população de receptores que recebeu pelo menos uma unidade anti-HCV reagente, apresentou um risco 29 vezes maior de adquirir esta hepatite, quando comparada aos receptores transfundidos com todas as unidades anti-HCV negativas. A realização do teste para a pesquisa do anti-HCV na triagem dos doadores de sangue, preveniria 79% dos casos de HVC pós-transfusionais.

Os candidatos a doadores brasileiros parecem ser acometidos simultânea ou sequencialmente, pelos vírus B e C das hepatites, pois, 44,4% dos doadores anti-HCV positivos, também foram anti-HBc positivos.

A realização dos testes para as pesquisas dos anticorpos anti-HBc e anti-HCV, nas triagens hemoterápicas, está indicada para prevenir a transmissão de hepatites pós-transfusionais, em nosso meio.

Unitermos: Hepatite por vírus C; Anti-HBc; Anti-HCV; Hepatites pós-transfusionais; Hepatite por vírus B.

SUMMARY

We have analysed anti-HBc and anti-HCV antibodies in serum samples from 799 donors which had their blood or derivates transfused to 111 recipients. Anti-HBc and anti-HCV were reactive in respectively 9 and 2.1% of the donors tested.

We have observed that among the 111 recipients, 44 had received at least one positive anti-HBc unit and 67 had been transfused only with negative anti-HBc, units. The risk of developing hepatitis C virus was 4.5 times higher for the recipients who received at least one positive anti-HBc unit. If the test for anti-HBc had been made for the blood donors in the serological screening, about 56% of the HCV cases in the recipients could have been avoided.

The population of recipients who received at least one reacting unit of anti-HCV, presented a risk 29 times higher of developing this hepatitis, as compared to the transfused recipients with all anti-HCV negative units. Testing blood from donors for anti-HCV would avoid 79% of the post-transfusional HCV cases.

Brazilian candidates to blood donors seem to be carriers either simultaneously or sequentially to hepatitis virus B and C, since 44.4% of the positive anti-HCV were also positive for anti-HBc.

Testing for anti-HBc and anti-HCV in blood screening must be indicated in order to prevent post-transfusional hepatitis transmission in our community.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

AGRADECIMENTOS

Agradecemos às enfermeiras Maria Sílvia Kroll Lazarini e Cláudia Maria Wolf, pela preciosa ajuda no seguimento dos doentes e à bióloga Giane Cristina Zen, pela realização dos testes sorológicos.

Recebido para publicação em 6/4/1992

Aceito para publicação em 12/11/1992

1. AACH, R.D.; SZMUNESS, W.; MOSLEY, J.W.; HOLLINGER, F.B.; KAHN, R.A.; STEVENS, C.E.; EDWARDS V.M. & WERCH, J. - Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients. New Engl. J. Med. 304: 989-994, 1981.
2. ALTER, H.J.; HOLLAND, P.V.; PURCELL, R.H.; LANDER, J.J.; FEINSTONE, S.M.; MORROW, A.G. & SCHMIDT, P.J. - Posttransfusion hepatitis after exclusion of commercial and hepatitis-B antigen-positive donors. Ann. intern. Med.,77: 691-699, 1972.
3. ALTER, H.J.; PURCELL, R.H.; HOLLAND, P.V.; ALLING, D.W. & KOZIOL, D.E. - Donors transaminase and recipient hepatitis. Impact on blood transfusion services. J. Amer. med. Ass., 246: 630-634, 1981.
4. ALTER, H.J.; PURCELL, R.H.; HOLLAND, P.V.; FEINSTONE, S.M.; MORROW, A.G. & MORTTSUGU, Y. - Clinical and sorological analysis of transfusion-associated hepatitis. Lancet, 2: 838-841, 1975.
5. ALTER, H.J.; PURCEL, R.H.; SHIH, J.W.; MELPOLDER, J.C: HOUGHTON, M.; CHOO, Q.L. & KUO, G. - Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. New Engl. J. Med., 321: 1494-1500, 1989.
6. AYMARD, J.P.; JANOT, C.; GAYET, S.; BUILLEMIN, C.; CANTON, P.; GAUCHER, P. & STREIFF, F. - Post-transfusion non-A, non-B hepatitis after cardiac surgery. Vox Sang. (Basel), 51: 236-238, 1986.
7. CHOO, Q.L.; KUO, G.; WEINER, A.J.; OVERBY, L.R.; BRADLEY, D.W. & HOUGHTON, M. - Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science, 244: 359-362, 1989.
8. COSSART, Y.E.; KIRSH, S. & ISMAY, S.L. - Post-transfusion hepatitis in Australia. Report of the Australian Red Cross study. Lancet, 1: 208-213, 1982.
9. DE SANTIS, G.C.; PRADO, B.P.A., Jr; SAVAIA, C.G.; COVAS, D.T.; SIMŐES, B.P. & BOTURĂO NETO, E. - Prevalęncia de marcadores para hepatite B em amostra de doadoes positivos para o anti-HBc. In: CONGRESSO DA SOCIEDADE BRASILEIRA DE HEMATOLOGIA, 19, Campinas, 1990. Anais. p.24.
10. ESTEBAN, J.I.; GONZÁLEZ, A.; HERNÁNDEZ, J.M.; VILADOMIU, L.; SÁNCHES, C.; LÓPEZ-TALAVERA, J.C.; LUCEA, D.; MARTIN-VEGA, C.; VIDAL, X.; ESTEBAN, R. & GUARDIA, J. - Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis. New Engl. J. Med., 323: 1107-1112, 1990.
11. GONÇALES Jr., F.L. - Estudo clínico-epidemiológico das hepatites pós-transfusionais. Papel dos principais marcadores sorológicos envolvidos na transmissăo. Campinas, 1991. (Tese de Doutoramento-Faculdade de Cięncias Médicas da Universidade Estadual de Campinas).
12. GONÇALES Jr., F.L.; BOCCATO, R.S.B.S.; GONÇALES, N.S.L.; SOUZA, C.A.; PELLEGRINO Jr., J. & MIGUEL, J.F.M. - Estudo da prevalęncia dos marcadores de hepatite B, especialmente o anti-HBc em 17084 doadores de sangue do Hemocentro do HC-UNICAMP. Rev. Soc. bras. Med. trop., 22 (supl.): 179, 1989.
13. GONÇALES Jr., F.L.; PEDRO, R.J.; BOCCATTO, R.S.B.S.; PAPAIORDANOU, P.M.O.; SOUZA, C.A.; PELLEGRINO Jr., J. & GONÇALES, N.S.L. - Prevalęncia dos marcadores sorológicos para os vírus das hepatites B e C, nos doadores de sangue do Hemocentro-UNICAMP. Rev. Soc. bras. Med. trop., 25 (supl.): 19, 1992.
14. HETLAND, G.; SKAUG, K.; LARSEN, J.; MAELAND, A.; STROMME, J.H. & STORVOLD, G. - Prevalence of anti-HVC in Norwegian blood donors with anti-HBc or increased ALT levels. Transfusion, 30: 776-779, 1990.
15. HOOFNAGLE, J.H. - Editorials. Posttransfusion hepatitis B. Transfusion, 30: 384-386, 1990.
16. HOOFNAGLE, J.H.; GERETY, R.J.; NI, L.Y. & BARKER, L.F. - Antibody to hepatitis B core antigen. A sensitive indicator of hepatitis B virus replication. New Engl. J. Med., 299: 1336-1340, 1974
17. HOOFNAGLE, J.H.; SEEFF, L.B.; BALES, Z.B.; ZIMMERMAN, H.J. & THE VETERANS ADMINISTRATION HEPATITIS COOPERATIVE STUDY GROUP - Type B hepatitis after transfusion with blood containing antibody to hepatitis B core antigen. New Engl. J. Med., 298: 1379-1383, 1978.
18. HOYOS, M.; SARRIÓN, J.V.; PÉREZ-CASTELANOS, T.; PRIETO, M.; MARTY, M.L.; GARRIGUES, V. & BERENGUER, J. - Prospective assessment of donor blood screening for antibody to hepatitis B core antigen as a means of preventing posttransfusion non-A, non-B hepatitis. Hepatology, 9: 449-451, 1989.
19. KATCHAKI, J.N.; SIEM, T.H. & BROWER, R. - Non-B post-transfusion hepatitis with hepatitis B core antibodies in donor blood. New Engl. J. Med., 307: 628, 1982.
20. KNODELL, R.G.; CONRAD, M.E.; DIENSTAG, J.L. & BELL, C.J. - Etiological espectrum of post-transfusion hepatitis. Gastroenterology, 69: 1278-1285, 1975.
21. KOZIOL, D.D.; HOLAND, P.V.; ALLING, D.W.; MELPOLDER, J.C.; SOLOMON, R.E.; PURCELL, R.H.; HUDSON, L.M.; SHOUP, F.J.; KRAKANER, H. & ALTER, H.J. - Antibody to hepatitis B core antigen as a paradoxical marker for non-A, non-B hepatitis agents in donated blood. Ann. intern. Med., 104: 488-495, 1986.
22. KUO, G.; CHOO, Q.L.; ALTER, H.J.; GITNICK, G.L.; REDEKER, A.G.; PURCELL, R.H.; MIYAMURA, T.; DIENSTAG, J.L.; ALTER, M.J.; STEVENS, C.E.; TEGT-MEIER, G.E.; BONINO, F.; COLOMBO, M.; LEE, W.S.; KUO, C.; BERGER, K.; SHUSTER, J.R.; OVERBY, L.R.; BRADLEY, D.W. & HOUGHTON, M. - An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science, 244: 362-364, 1989.
23. MAUSNER, J.S. & BAHN, A.K. - Epidemiology. An introductory text. Philadelphia W.B. Saunders, 1974.
24. MORRIS, E.M. - Paradoxical marker of non-A, non-B hepatitis (letter). Ann. Intern. Med., 105: 294, 1986.
25. OHTO, H. & NINOMIYA, K. - Donor anti-HBc and ALT and non-A, non B hepatitis. Transfusion, 29: 277-278, 1989.
26. PRINCE, A.M.; BROTMAN, B;GRADY, G.F.; KUHNS, W.J.; HAZZI, C.; LEVINE, R.W. & MILLIAN, S.J. - Long-incubation post-transfusion hepatitis without serological evidence of exposure to hepatitis-B virus. Lancet, 2: 241-246, 1974.
27. RAKELA, J.; MOSLEY, J.W.; AACH, R.D.; GITNICK, G.L.; HOLLINGER, F.B.; STEVENS, C.E. & SZMUNESS, W. - Viral hepatitis after transfusion with blood containing antibody to hepatitis B core antigen. Gastroenterology, 78: 1318, 1980.
28. ROBINSON, W.S. - The enigma of non-A, non-B hepatitis. J. Infect. Dis., 145: 387-395, 1982.
29. STEVENS, C.E.; AACH, R.D.: HOLLINGER, B.; MOSLEY, J.W.; SZMUNESS, W.; KAHN, R.; WERCH, J. & EDWARDS, V. - Hepatitis B virus antibody in blood donors and the occurrence of non-A, non-B hepatitis in transfusion recipients. An analysis of the Transfusion-Transmitted Viruses Study. Ann. intern. Med., 101: 733-738, 1984.
30. STEVENS, C.E. & THE TRANSFUSION-TRANSMITTED VIRUSES STUDY GROUP - Antibody to hepatitis B core antigen in donor blood and the risk of non-A, non-B hepatitis in recipients. Transfusion, 21: 607, 1981.
31. SUGG, U.; SCHENZLE, D. & HESS, G. - Antibodies to hepatitis B core antigen in blood donors screened for alamine aminotransferase level and hepatitis non-A, non-B in recipients. Transfusion, 28: 386-388, 1988.
32. TABOR, E.; HOOFNAGLE, J.H.; SMALLWOOD, L.A.; DRUCKER, J.A.; PINEDA-TAMONDONG, G.C.; NI, L.Y.; GREENWALT, T.J.; BARKER, L.F. & GERETY, R.J. - Studies of donors who transmit posttransfusion hepatitis. Transfusion, 19: 725-731, 1979.
33. VYAS, G.N. & BLUM, H.E. - Non-B post-transfusion hepatitis with hepatitis B core antibodies in donor blood (second letter). New Engl. J. Med. 307: 628-629, 1982.
34. VYAS, G.N. & PERKINS, H.A. - Non-B post-transfusion hepatitis associated with hepatitis B core antibodies in donor blood. New Engl. J. Med, 306: 749-750, 1982.

Endereço para correspondência:

Prof. Dr. Fernando Lopes Gonçales Junior

Disciplina de Doenças Transmissíveis da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP)

Caixa Postal 1170

CEP 13081. Campinas, São Paulo, Brasil

Datas de Publicação

Publicação nesta coleção
11 Set 2006
Data do Fascículo
Fev 1993

Histórico

Aceito
12 Nov 1992
Recebido
06 Abr 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. AACH, R.D.; SZMUNESS, W.; MOSLEY, J.W.; HOLLINGER, F.B.; KAHN, R.A.; STEVENS, C.E.; EDWARDS V.M. & WERCH, J. - Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients. New Engl. J. Med. 304: 989-994, 1981.

[2] 2. ALTER, H.J.; HOLLAND, P.V.; PURCELL, R.H.; LANDER, J.J.; FEINSTONE, S.M.; MORROW, A.G. & SCHMIDT, P.J. - Posttransfusion hepatitis after exclusion of commercial and hepatitis-B antigen-positive donors. Ann. intern. Med.,77: 691-699, 1972.

[3] 3. ALTER, H.J.; PURCELL, R.H.; HOLLAND, P.V.; ALLING, D.W. & KOZIOL, D.E. - Donors transaminase and recipient hepatitis. Impact on blood transfusion services. J. Amer. med. Ass., 246: 630-634, 1981.

[4] 4. ALTER, H.J.; PURCELL, R.H.; HOLLAND, P.V.; FEINSTONE, S.M.; MORROW, A.G. & MORTTSUGU, Y. - Clinical and sorological analysis of transfusion-associated hepatitis. Lancet, 2: 838-841, 1975.

[5] 5. ALTER, H.J.; PURCEL, R.H.; SHIH, J.W.; MELPOLDER, J.C: HOUGHTON, M.; CHOO, Q.L. & KUO, G. - Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. New Engl. J. Med., 321: 1494-1500, 1989.

[6] 6. AYMARD, J.P.; JANOT, C.; GAYET, S.; BUILLEMIN, C.; CANTON, P.; GAUCHER, P. & STREIFF, F. - Post-transfusion non-A, non-B hepatitis after cardiac surgery. Vox Sang. (Basel), 51: 236-238, 1986.

[7] 7. CHOO, Q.L.; KUO, G.; WEINER, A.J.; OVERBY, L.R.; BRADLEY, D.W. & HOUGHTON, M. - Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science, 244: 359-362, 1989.

[8] 8. COSSART, Y.E.; KIRSH, S. & ISMAY, S.L. - Post-transfusion hepatitis in Australia. Report of the Australian Red Cross study. Lancet, 1: 208-213, 1982.

[9] 9. DE SANTIS, G.C.; PRADO, B.P.A., Jr; SAVAIA, C.G.; COVAS, D.T.; SIMŐES, B.P. & BOTURĂO NETO, E. - Prevalęncia de marcadores para hepatite B em amostra de doadoes positivos para o anti-HBc. In: CONGRESSO DA SOCIEDADE BRASILEIRA DE HEMATOLOGIA, 19, Campinas, 1990. Anais. p.24.

[10] 10. ESTEBAN, J.I.; GONZÁLEZ, A.; HERNÁNDEZ, J.M.; VILADOMIU, L.; SÁNCHES, C.; LÓPEZ-TALAVERA, J.C.; LUCEA, D.; MARTIN-VEGA, C.; VIDAL, X.; ESTEBAN, R. & GUARDIA, J. - Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis. New Engl. J. Med., 323: 1107-1112, 1990.

[11] 11. GONÇALES Jr., F.L. - Estudo clínico-epidemiológico das hepatites pós-transfusionais. Papel dos principais marcadores sorológicos envolvidos na transmissăo. Campinas, 1991. (Tese de Doutoramento-Faculdade de Cięncias Médicas da Universidade Estadual de Campinas).

[12] 12. GONÇALES Jr., F.L.; BOCCATO, R.S.B.S.; GONÇALES, N.S.L.; SOUZA, C.A.; PELLEGRINO Jr., J. & MIGUEL, J.F.M. - Estudo da prevalęncia dos marcadores de hepatite B, especialmente o anti-HBc em 17084 doadores de sangue do Hemocentro do HC-UNICAMP. Rev. Soc. bras. Med. trop., 22 (supl.): 179, 1989.

[13] 13. GONÇALES Jr., F.L.; PEDRO, R.J.; BOCCATTO, R.S.B.S.; PAPAIORDANOU, P.M.O.; SOUZA, C.A.; PELLEGRINO Jr., J. & GONÇALES, N.S.L. - Prevalęncia dos marcadores sorológicos para os vírus das hepatites B e C, nos doadores de sangue do Hemocentro-UNICAMP. Rev. Soc. bras. Med. trop., 25 (supl.): 19, 1992.

[14] 14. HETLAND, G.; SKAUG, K.; LARSEN, J.; MAELAND, A.; STROMME, J.H. & STORVOLD, G. - Prevalence of anti-HVC in Norwegian blood donors with anti-HBc or increased ALT levels. Transfusion, 30: 776-779, 1990.

[15] 15. HOOFNAGLE, J.H. - Editorials. Posttransfusion hepatitis B. Transfusion, 30: 384-386, 1990.

[16] 16. HOOFNAGLE, J.H.; GERETY, R.J.; NI, L.Y. & BARKER, L.F. - Antibody to hepatitis B core antigen. A sensitive indicator of hepatitis B virus replication. New Engl. J. Med., 299: 1336-1340, 1974

[17] 17. HOOFNAGLE, J.H.; SEEFF, L.B.; BALES, Z.B.; ZIMMERMAN, H.J. & THE VETERANS ADMINISTRATION HEPATITIS COOPERATIVE STUDY GROUP - Type B hepatitis after transfusion with blood containing antibody to hepatitis B core antigen. New Engl. J. Med., 298: 1379-1383, 1978.

[18] 18. HOYOS, M.; SARRIÓN, J.V.; PÉREZ-CASTELANOS, T.; PRIETO, M.; MARTY, M.L.; GARRIGUES, V. & BERENGUER, J. - Prospective assessment of donor blood screening for antibody to hepatitis B core antigen as a means of preventing posttransfusion non-A, non-B hepatitis. Hepatology, 9: 449-451, 1989.

[19] 19. KATCHAKI, J.N.; SIEM, T.H. & BROWER, R. - Non-B post-transfusion hepatitis with hepatitis B core antibodies in donor blood. New Engl. J. Med., 307: 628, 1982.

[20] 20. KNODELL, R.G.; CONRAD, M.E.; DIENSTAG, J.L. & BELL, C.J. - Etiological espectrum of post-transfusion hepatitis. Gastroenterology, 69: 1278-1285, 1975.

[21] 21. KOZIOL, D.D.; HOLAND, P.V.; ALLING, D.W.; MELPOLDER, J.C.; SOLOMON, R.E.; PURCELL, R.H.; HUDSON, L.M.; SHOUP, F.J.; KRAKANER, H. & ALTER, H.J. - Antibody to hepatitis B core antigen as a paradoxical marker for non-A, non-B hepatitis agents in donated blood. Ann. intern. Med., 104: 488-495, 1986.

[22] 22. KUO, G.; CHOO, Q.L.; ALTER, H.J.; GITNICK, G.L.; REDEKER, A.G.; PURCELL, R.H.; MIYAMURA, T.; DIENSTAG, J.L.; ALTER, M.J.; STEVENS, C.E.; TEGT-MEIER, G.E.; BONINO, F.; COLOMBO, M.; LEE, W.S.; KUO, C.; BERGER, K.; SHUSTER, J.R.; OVERBY, L.R.; BRADLEY, D.W. & HOUGHTON, M. - An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science, 244: 362-364, 1989.

[23] 23. MAUSNER, J.S. & BAHN, A.K. - Epidemiology. An introductory text. Philadelphia W.B. Saunders, 1974.

[24] 24. MORRIS, E.M. - Paradoxical marker of non-A, non-B hepatitis (letter). Ann. Intern. Med., 105: 294, 1986.

[25] 25. OHTO, H. & NINOMIYA, K. - Donor anti-HBc and ALT and non-A, non B hepatitis. Transfusion, 29: 277-278, 1989.

[26] 26. PRINCE, A.M.; BROTMAN, B;GRADY, G.F.; KUHNS, W.J.; HAZZI, C.; LEVINE, R.W. & MILLIAN, S.J. - Long-incubation post-transfusion hepatitis without serological evidence of exposure to hepatitis-B virus. Lancet, 2: 241-246, 1974.

[27] 27. RAKELA, J.; MOSLEY, J.W.; AACH, R.D.; GITNICK, G.L.; HOLLINGER, F.B.; STEVENS, C.E. & SZMUNESS, W. - Viral hepatitis after transfusion with blood containing antibody to hepatitis B core antigen. Gastroenterology, 78: 1318, 1980.

[28] 28. ROBINSON, W.S. - The enigma of non-A, non-B hepatitis. J. Infect. Dis., 145: 387-395, 1982.

[29] 29. STEVENS, C.E.; AACH, R.D.: HOLLINGER, B.; MOSLEY, J.W.; SZMUNESS, W.; KAHN, R.; WERCH, J. & EDWARDS, V. - Hepatitis B virus antibody in blood donors and the occurrence of non-A, non-B hepatitis in transfusion recipients. An analysis of the Transfusion-Transmitted Viruses Study. Ann. intern. Med., 101: 733-738, 1984.

[30] 30. STEVENS, C.E. & THE TRANSFUSION-TRANSMITTED VIRUSES STUDY GROUP - Antibody to hepatitis B core antigen in donor blood and the risk of non-A, non-B hepatitis in recipients. Transfusion, 21: 607, 1981.

[31] 31. SUGG, U.; SCHENZLE, D. & HESS, G. - Antibodies to hepatitis B core antigen in blood donors screened for alamine aminotransferase level and hepatitis non-A, non-B in recipients. Transfusion, 28: 386-388, 1988.

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