Incidência pós-transfusional do HBsAg em crianças com doenças neoplásicas / Post-transfusional incidence of HBsAg in children with neoplastic diseases

Há 350 milhões de indivíduos cronicamente infectados pelo vírus da hepatite B (VHB). O desenvolvimento e a gravidade dessa infecção dependem de vários fatores, tais como a idade da primoinfecção e resposta imune, sendo o risco dessa cronificação menor que 5 por cento em adultos e maior que 90 por cento em neonatos. Indivíduo cronicamente infectado pelo VHB durante a infância tem 25 por cento de chance de morrer por cirrose ou hepatocarcinoma. Tais evidências conduziram os autores a desenvolver este estudo cujo objetivo foi estimar a incidência pós-transfusional do antígeno de superfície do vírus da hepatite B (HBsAg) em crianças com neoplasias, que foram transfundidas no curso do tratamento ou seguimento da doença. Foi realizado um estudo retrospectivo, com revisão de 333 prontuários do serviço de oncologia do HIVS, de janeiro de 1993 a janeiro de 2005. Adotaram-se como critérios de inclusão: idade menor que 16 anos, diagnóstico de doença neoplásica e realização da pesquisa do HBsAg. Assim, 199 prontuários foram excluídos por não preencherem tais critérios, restando 134 que foram analisados quanto à realização de hemotransfusão. Das 134 crianças, 116 foram transfundidas e 18 não. Apresentaram pesquisa reativa para o HBsAg 32,8 por cento das transfundidas e apenas 5,6 por cento das não-transfundidas. O teste Exato de Fisher mostrou que houve significância estatística (p = 0,023) e observou-se que as proporções de pacientes com pesquisa reativa diferem entre os transfundidos e os não-transfundidos. O odds ratio de um paciente transfundido apresentar pesquisa reativa para o HBsAg foi calculado em 8,28 vezes maior do que um não-transfundido.

There are 350 million individuals infected by the hepatitis B virus (HBV). The development and the severity of the infection depend on several factors, such as: age at the first infection and the immunity response of the subject. The risk of chronic infection is less than 5 percent for adults and greater than 90 percent for newborn babies. An individual who is chronically infected by HBV during childhood has a 25 percent risk of dying due to cirrhosis or liver cancer. This data led the authors to design a study with the objective of estimating the post-transfusion incidence of the hepatitis B virus surface antigen (HBsAg) in children with neoplasias who were transfused during treatment or during the follow up. A retrospective study was performed that revisited 333 medical records from the oncology service in the HIVS from January 1993 to January 2005. The inclusion criteria were: age less than 16 years old, diagnosis of cancer and the results of the HBsAg test. Thus, 199 patients were excluded because they did not fulfill the criteria. The remaining 134 patients' records were analyzed in regards to blood transfusion. Of the 134 children who satisfied the criteria, 116 were transfused and 18 were not. Results of the HBsAg test were positive in 32.8 percent of the transfused patients and in only 5.6 percent of non-transfused individuals. The Fisher Exact Test demonstrated a statistically significant difference (p = 0.023). The ODDS ratio of a transfused patient presenting with reactive results for HBsAG was calculated at 8.28 times greater than non-transfused individuals.

Prevalence of the TT virus viremia in Patients on Hemodialysis and General Populations / 대한진단검사의학회지

BACKGROUND: The TT virus (TTV) is a recently discovered, single-stranded circular DNA virus in the serum of the patients with post-transfusion hepatitis and it is thought to be one of the causative agents of cryptogenic hepatitis. In this study, we evaluated the prevalence and clinical significance of TTV viremia in general populations and patients on hemodialysis. METHODS: Sera of 115 general populations and 69 patients on hemodialysis were examined for TTV viremia by semi-nested polymerase chain reaction using primers deduced from the N22 region. RESULTS: The TTV was detected in 26.1% (18 of 69) of the patients on hemodialysis and was not different from the 20.9% (24 of 115) prevalence in general populations. Two patients on hemodialysis that revealed biochemical evidence of acute hepatitis were the sole TTV infection without other hepatitis virus infection but the mean alanine aminotransferase level was not significantly different according to the TTV viremia. The TTV was persistently detected in the sera of eight of thirteen patients (61.5%) 12 month later without any evidence of hepatitis. CONCLUSIONS: TTV is widespread in general populations and shows similar prevalence in patients on hemodialysis. Viral persistence and nonparenteral transmission may be possible. The relationship between the TTV viremia and hepatitis was not proved.

Seroincidence of Hepatitis B Virus among Korean Blood Donors

BACKGROUND: Seroincidence of hepatitis B virus (HBV) among Korean blood donors has not been reported. This study was conducted to calculate the seroincidence of HBV among blood donors and to estimate the risk of post-transfusion hepatitis B by donated blood in window period of infection. METHODS: HBV seroincidence was calculated among repeat-donors who had donated from Nov. 1994 through Dec. 1996. To calculate the person-years, the database of the Korean National Red Cross was used in which results for HBsAg enzyme immunoassay were filed up. The observed incidence was adjusted by interdonation interval of incident cases, who were defined as donors showing seroconversion. The risk of post-transfusion hepatitis B by donated bloods in window period of infection was estimated. RESULTS: HBV seroincidence was estimated to be 180.85/100,000 person-years. This was adjusted as 602.83/100,000 person-years by considering interdonation intervals. The risk of post-transfusion hepatitis B was estimated to be 974 units per one million of whole blood units due to be in window period of infection. CONCLUSION: The estimated seroincidence of HBV among Korean blood donors and thereby the risk of HBV transmission by donated bloods in window period of infection was about 50 to 60 times higher than those of Japan and United States of America.(Korean J Blood Transfusion 10(1): 1-4, 1999)

Seroincidence of Hepatitis B Virus among Korean Blood Donors / 대한수혈학회지

BACKGROUND: Seroincidence of hepatitis B virus (HBV) among Korean blood donors has not been reported. This study was conducted to calculate the seroincidence of HBV among blood donors and to estimate the risk of post-transfusion hepatitis B by donated blood in window period of infection. METHODS: HBV seroincidence was calculated among repeat-donors who had donated from Nov. 1994 through Dec. 1996. To calculate the person-years, the database of the Korean National Red Cross was used in which results for HBsAg enzyme immunoassay were filed up. The observed incidence was adjusted by interdonation interval of incident cases, who were defined as donors showing seroconversion. The risk of post-transfusion hepatitis B by donated bloods in window period of infection was estimated. RESULTS: HBV seroincidence was estimated to be 180.85/100,000 person-years. This was adjusted as 602.83/100,000 person-years by considering interdonation intervals. The risk of post-transfusion hepatitis B was estimated to be 974 units per one million of whole blood units due to be in window period of infection. CONCLUSION: The estimated seroincidence of HBV among Korean blood donors and thereby the risk of HBV transmission by donated bloods in window period of infection was about 50 to 60 times higher than those of Japan and United States of America.

Aspectos evolutivos da hepatite C pós-transfusional: revisão de 175 casos / Evolutive aspects of post-transfusion hepatitis C: review of 175 cases

O vírus da hepatite C é o principal responsável pela hepatite pós-transfusional e sua progressão para hepatite crônica, cirrose e carcinoma hepatocelular é muito comum. A fim de avaliar frequência, tempo e fatores relacionados à progressão da hepatite C, estudamos 175 pacientes com hepatite C pós-transfusional. Estes foram divididos em 2 grupos com cirrose (n = 92) e sem cirrose (n = 83). O tempo médio de desenvolvimento de cirrose foi de 11 ± 6 anos. Pacientes com cirrose eram mais velhos à época da transfusão, apresentavam maior prevalência de alcoolismo e tinham tempo de evolução mais longo. O prognóstico foi pior no grupo com cirrose com 28,4% de mortalidade e 9,1% de carcinoma hepatocelular, comparados a 5,5% e 0% no grupo sem cirrose, respectivamente. Concluímos que a hepatite C pós-transfusional é uma doença progressiva, que se agrava com o passar do tempo, progridindo mais rapidamente em idosos e pacientes com outros fatores de agressão hepática.

Hepatitis C virus is the main agent responsible for post-transfusion hepatitis. Progression to chronic hepatitis, cirrhosis and hepatocellular carcinoma is very common. The aim of this study was to evaluate the frequency, timing and factors related to progression of hepatitis C. One hundred seventy five patients with chronic post-transfusion hepatitis C were grouped in a cirrhosis group (n = 92) and a non-cirrhosis group (n = 83). The medium time of development to cirrhosis was 11 +/- 6 years. Patients with cirrhosis were older at the time they received transfusion, used more alcohol and had longer times of evolution. The prognosis was worse in the cirrhosis group with a mortality rate of 28.4% and 9.1% of evolution towards hepatocellular carcinoma, comparing with 5.5% and 0% in the non-cirrhosis group respectively. It is shown that post-transfusion hepatitis C is slowly developing progressive disease which progress is much more rapidly in elderly patients and patients with others factors of liver damage.