Hepatites pós-transfusionais na cidade de Campinas, SP, Brasil: I. Incidência, agentes etiológicos e aspectos clínico-epidemiológicos da hepatite por vírus C

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

doi:10.1590/S0036-46651993000100008

Resumos

Seguimos ambulatorialmente, por no mínimo 180 dias, 111 receptores de transfusões, para avaliarmos a ocorrência de hepatites pós-transfusionais e os agentes etiológicos envolvidos com esta doença, na cidade de Campinas, Estado de São Paulo, Brasil. No final diagnosticamos esta hepatite em 18 (16,2%) receptores. Destes, tivemos 16 (89%) casos devido ao vírus da hepatite C, 1 (5,5%) causado pelo vírus da hepatite B e 1 (5,5%) caso restante, sem etiologia determinada, 15 meses após a transfusão. O período de incubação da hepatite por vírus C (HVC) foi de 71 dias, em média; e 23% dos indivíduos com esta hepatite permaneceram com aumento de AST/ALT por mais de 6 meses. Observou-se soroconversão tardia para o anti-HCV em 71,4% dos receptores, que ocorreu, em média, 135 dias após a transfusão. Uma dosagem de ALT e uma pesquisa do anti-HCV, aos 3 e 6 meses, após a transfusão, diagnosticariam, respectivamente, 71 e 93% dos casos que desenvolveram HVC pós-transfusionais.

Hepatite por virus C; Anti-HCV; Hepatites pós-transfusionais; Hepatite não-A, não-B; Hepatite B

We have followed up 111 transfusion receptors in the ambulatory, for at least 180 days, in order to evaluate the occurence of post-transfusional hepatitis and the etiological agents involved in the disease in the city of Campinas, state of São Paulo, Brazil. At the end of the study we have diagnosed this hepatitis in 18 (16.2%) subjects. Out of these 18 subjects, 16 (89%) were caused by hepatitis C virus, 1 (5.5%) caused by hepatitis B virus and 1 (5.5%) with undetermined etiology, 15 months after transfusion. The average incubation period of HCV was 71 days and 23% of the HCV positive receptors remained with increased AST/ ALT for more than 6 months. Late serum conversion was observed for anti-HCV in 71.4% of the subjects, averaging 135 days after the transfusion. An ALT dosage and anti-HCV determination, 3 and 6 months after transfusion would diagnose, respectively, 71 and 93% of the cases which developed post-transfusional HCV.

EPIDEMIOLOGIA

Hepatites pós-transfusionais na cidade de Campinas, SP, Brasil. I. Incidência, agentes etiológicos e aspectos clínico-epidemiológicos da hepatite por vírus C

Post-transfusional hepatitis in the city of Campinas, SP, Brazil. I. Incidence, etiological agents and clinical-epidemiological aspects of hepatitis C virus

Fernando Lopes Gonçales Júnior^I; Rogério de Jesus Pedro^I; Luiz Jacintho da Silva^I; Raquel Silveira Bello Stucchi Boccato^I; Marcelo Carvalho Ramos^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

Seguimos ambulatorialmente, por no mínimo 180 dias, 111 receptores de transfusões, para avaliarmos a ocorrência de hepatites pós-transfusionais e os agentes etiológicos envolvidos com esta doença, na cidade de Campinas, Estado de São Paulo, Brasil. No final diagnosticamos esta hepatite em 18 (16,2%) receptores. Destes, tivemos 16 (89%) casos devido ao vírus da hepatite C, 1 (5,5%) causado pelo vírus da hepatite B e 1 (5,5%) caso restante, sem etiologia determinada, 15 meses após a transfusão. O período de incubação da hepatite por vírus C (HVC) foi de 71 dias, em média; e 23% dos indivíduos com esta hepatite permaneceram com aumento de AST/ALT por mais de 6 meses. Observou-se soroconversão tardia para o anti-HCV em 71,4% dos receptores, que ocorreu, em média, 135 dias após a transfusão. Uma dosagem de ALT e uma pesquisa do anti-HCV, aos 3 e 6 meses, após a transfusão, diagnosticariam, respectivamente, 71 e 93% dos casos que desenvolveram HVC pós-transfusionais.

Unitermos: Hepatite por virus C; Anti-HCV; Hepatites pós-transfusionais; Hepatite não-A, não-B; Hepatite B.

SUMMARY

We have followed up 111 transfusion receptors in the ambulatory, for at least 180 days, in order to evaluate the occurence of post-transfusional hepatitis and the etiological agents involved in the disease in the city of Campinas, state of São Paulo, Brazil. At the end of the study we have diagnosed this hepatitis in 18 (16.2%) subjects. Out of these 18 subjects, 16 (89%) were caused by hepatitis C virus, 1 (5.5%) caused by hepatitis B virus and 1 (5.5%) with undetermined etiology, 15 months after transfusion. The average incubation period of HCV was 71 days and 23% of the HCV positive receptors remained with increased AST/ ALT for more than 6 months. Late serum conversion was observed for anti-HCV in 71.4% of the subjects, averaging 135 days after the transfusion. An ALT dosage and anti-HCV determination, 3 and 6 months after transfusion would diagnose, respectively, 71 and 93% of the cases which developed post-transfusional HCV.

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AGRADECIMENTOS

Agradecemos às enfermeiras Maria Silvia 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.; PURCELL, R.H.; HOLLAND, P.V.; FEINSTONE, S.M.; MORROW, A.G. & MORITSUGU, Y. - Clinical and sorological analysis of transfusion-associated hepatitis. Lancet, 2: 838-841, 1975.
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.; 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.
5. ALTER, H.J.; TEGTMEIER, G.E; JETT, B.W.; QUAN, S.; SHIH, J.W.; BAYER, W.L. & POLITO, A. - The use of a recombinant immunoblot assay in the interpretation of anti-hepatitis C virus reactivity among prospectively followed patients, implicated donors, and random donors. Transfusion, 31: 771-776, 1991.
6. AYMARD, J.P.; JANOT, C.; GAYET, S.; GUILLEMIN, 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. BLUMBERG, B.S.; ALTER, H.J. & VISNICH S. - A. "new" antigen in leukemia sera. J. Amer. med. Ass., 191: 541-546, 1965.
8. BLUMBERG, B.S.; SUTNICK, A.I. & LONDON, W.T. - Australia antigen and hepatitis. J. Amer. med. Ass., 207: 1895-1896, 1969.
9. 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.
10. COLOMBO, M.; OLDANI, S.; DONATO, M.F.; BORZIO, M.; SANTERE, R.; ROFFI, L.; VIGANÓ, P. & CARGNEL, A. - A multicenter prospective study of post-transfusion hepatitis in Milan. Hepatology, 7: 709-712, 1987.
11. CONRAD, M.E.; KNODELL, R.G.; BRADLEY, E.L., Jr.; FLANNERY, E.P. & GINSBERG, A.L. - Risk factors in transmission of non-A, non-B post-transfusion hepatitis. Transfusion, 17: 579-585, 1977.
12. COSSART, Y.E.; KIRSCH, S. & ISMAY, S.L. - Post-transfusion hepatitis in Australia. Report of the Australian Red Cross study. Lancet, 1: 208-213, 1982.
13. ESTEBAN, J.I.; ESTEBAN, R.; VILADOMIU, L.; LOPEZ-TALAVERA, J.C.; GONZÁLEZ, A.; HERNANDEZ, J.M.; ROGET, M.; VARGAS, V.; BENESCA, J.; BUTI, M.; GUARDIA, J.; HOUGHTON, M.; CHOO, Q.L. & KUO, G. - Hepatitis C virus antibodies among risk groups in Spain. Lancet, 2: 294-297, 1989.
14. ESTEBAN, J.I.; GONZÁLEZ, A.; HERNÁNDEZ, J.M.; VILADOMIU, L.; SÁNCHEZ, 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.
15. HOOFNAGLE, J.H. - Editorials. Posttransfusion hepatitis B. Transfusion, 30: 384-386, 1990.
16. 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.
17. 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 preventing posttransfusion non-A, non-B hepatitis. Hepatoiogy, 9: 449-451, 1989.
18. KATAYAMA, T.; KIKUCHI, S.; TANAKA, Y.; SAITO, I.; MIYAMURA, T.; CHOO, Q.L.; HOUGHTON, M. & KUO, G. - Blood screening for non-A, non-B hepatitis by hepatitis C virus antibody assay. Transfusion, 30: 374-376, 1990.
19. KATCHAKI, J.N.; SIEM. T.H. & BROUWER, 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. KNODELL, R.G.; CONRAD, M.E.; GINSBERG, A.L. & BELL, C.J. - Efficacy of prophylatic gamma-globulin in preventing non-A, non-B post-transfusion hepatitis. Lancet, 1: 557-561, 1976.
22. KOZIOL, D.E.; 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.
23. KUO, G.; CHOO, O.L.; ALTER, H.J.; GITNICK, G.L.; REDEKER, A.G.; PURCELL, R.H.; MIYAMURA, T.; DIENSTAG, J.L.; ALTER, M.J.; STEVENS, C.E.; TEGTMEIER, 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.
24. LARSEN, J.; HETLAND, G. & SKANG, K. - Posttransfusion hepatitis B transmitted by blood from a hepatitis B surface antigen-negative hepatitis B virus carrier. Transfusion, 30: 431-432, 1990.
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. PROHASKA, W.; WOLFF, C.; LECHLER, E. & KLEESIEK, K. - High rate of false positives in Wood donor screening for antibodies to hepatitis C virus. Klin. Wochenschr., 69: 294-296, 1991.
28. 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.
29. RICHARD, D. - The usefulness of surrogate markers anti-HBc and ALT for post-transfusion non-A, non-B hepatitis prevention. J. virol. Meth., 17: 105-117, 1987.
30. ROBINSON, W.S. - The enigma of non-A, non-B hepatitis. J. Infect. Dis., 145: 387-395, 1982.
31. STEVENS, C.E.; AACH, R.D.; HOLLINGER, B.; MOSLEY, J.W.; SZMUNESS, W.; KAHN, R.; WERCH, J. & EDWARDS, V. - Hepatitis B virus antibody in Wood 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.
32. STEVENS, C.E. & THE TRANSFUSION-TRANSMITTED VIRUSES STUDY GROUP - Antibody to hepatitis B 61 core antigen in donor blood and the risk of non-A, non-B hepatitis in recipients. Transfusion, 21: 607, 1981.
33. 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.
34; TABOR, E.; HOOFNAGLE, J.H.; SMALLWOOD, L.A.; DRUKER, 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.
35. 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.; PURCELL, R.H.; HOLLAND, P.V.; FEINSTONE, S.M.; MORROW, A.G. & MORITSUGU, Y. - Clinical and sorological analysis of transfusion-associated hepatitis. Lancet, 2: 838-841, 1975.

[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.; 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.

[5] 5. ALTER, H.J.; TEGTMEIER, G.E; JETT, B.W.; QUAN, S.; SHIH, J.W.; BAYER, W.L. & POLITO, A. - The use of a recombinant immunoblot assay in the interpretation of anti-hepatitis C virus reactivity among prospectively followed patients, implicated donors, and random donors. Transfusion, 31: 771-776, 1991.

[6] 6. AYMARD, J.P.; JANOT, C.; GAYET, S.; GUILLEMIN, 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. BLUMBERG, B.S.; ALTER, H.J. & VISNICH S. - A. "new" antigen in leukemia sera. J. Amer. med. Ass., 191: 541-546, 1965.

[8] 8. BLUMBERG, B.S.; SUTNICK, A.I. & LONDON, W.T. - Australia antigen and hepatitis. J. Amer. med. Ass., 207: 1895-1896, 1969.

[9] 9. 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.

[10] 10. COLOMBO, M.; OLDANI, S.; DONATO, M.F.; BORZIO, M.; SANTERE, R.; ROFFI, L.; VIGANÓ, P. & CARGNEL, A. - A multicenter prospective study of post-transfusion hepatitis in Milan. Hepatology, 7: 709-712, 1987.

[11] 11. CONRAD, M.E.; KNODELL, R.G.; BRADLEY, E.L., Jr.; FLANNERY, E.P. & GINSBERG, A.L. - Risk factors in transmission of non-A, non-B post-transfusion hepatitis. Transfusion, 17: 579-585, 1977.

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

[13] 13. ESTEBAN, J.I.; ESTEBAN, R.; VILADOMIU, L.; LOPEZ-TALAVERA, J.C.; GONZÁLEZ, A.; HERNANDEZ, J.M.; ROGET, M.; VARGAS, V.; BENESCA, J.; BUTI, M.; GUARDIA, J.; HOUGHTON, M.; CHOO, Q.L. & KUO, G. - Hepatitis C virus antibodies among risk groups in Spain. Lancet, 2: 294-297, 1989.

[14] 14. ESTEBAN, J.I.; GONZÁLEZ, A.; HERNÁNDEZ, J.M.; VILADOMIU, L.; SÁNCHEZ, 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.

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

[16] 16. 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.

[17] 17. 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 preventing posttransfusion non-A, non-B hepatitis. Hepatoiogy, 9: 449-451, 1989.

[18] 18. KATAYAMA, T.; KIKUCHI, S.; TANAKA, Y.; SAITO, I.; MIYAMURA, T.; CHOO, Q.L.; HOUGHTON, M. & KUO, G. - Blood screening for non-A, non-B hepatitis by hepatitis C virus antibody assay. Transfusion, 30: 374-376, 1990.

[19] 19. KATCHAKI, J.N.; SIEM. T.H. & BROUWER, 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. KNODELL, R.G.; CONRAD, M.E.; GINSBERG, A.L. & BELL, C.J. - Efficacy of prophylatic gamma-globulin in preventing non-A, non-B post-transfusion hepatitis. Lancet, 1: 557-561, 1976.

[22] 22. KOZIOL, D.E.; 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.

[23] 23. KUO, G.; CHOO, O.L.; ALTER, H.J.; GITNICK, G.L.; REDEKER, A.G.; PURCELL, R.H.; MIYAMURA, T.; DIENSTAG, J.L.; ALTER, M.J.; STEVENS, C.E.; TEGTMEIER, 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.

[24] 24. LARSEN, J.; HETLAND, G. & SKANG, K. - Posttransfusion hepatitis B transmitted by blood from a hepatitis B surface antigen-negative hepatitis B virus carrier. Transfusion, 30: 431-432, 1990.

[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. PROHASKA, W.; WOLFF, C.; LECHLER, E. & KLEESIEK, K. - High rate of false positives in Wood donor screening for antibodies to hepatitis C virus. Klin. Wochenschr., 69: 294-296, 1991.

[28] 28. 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.

[29] 29. RICHARD, D. - The usefulness of surrogate markers anti-HBc and ALT for post-transfusion non-A, non-B hepatitis prevention. J. virol. Meth., 17: 105-117, 1987.

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

[31] 31. STEVENS, C.E.; AACH, R.D.; HOLLINGER, B.; MOSLEY, J.W.; SZMUNESS, W.; KAHN, R.; WERCH, J. & EDWARDS, V. - Hepatitis B virus antibody in Wood 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.

[32] 32. STEVENS, C.E. & THE TRANSFUSION-TRANSMITTED VIRUSES STUDY GROUP - Antibody to hepatitis B 61 core antigen in donor blood and the risk of non-A, non-B hepatitis in recipients. Transfusion, 21: 607, 1981.

[33] 33. 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.

[34] 34; TABOR, E.; HOOFNAGLE, J.H.; SMALLWOOD, L.A.; DRUKER, 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.

[35] 35. 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.

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