Significance of anti-HBc screening of blood donors & its association with occult hepatitis B virus infection: Implications for blood transfusion.

Background & objective: Expansions of blood donor screening and improved laboratory detection of viral markers have remarkably reduced the risk for infection with transfusion-transmitted viruses. This study was aimed to evaluate the presence of anti-HBc and to determine the presence or absence of HBV DNA in the serum samples from HBsAg negative, anti-HBc positive blood donors in a tertiary care hospital blood bank from Delhi. Methods: A total of 2175 HBsAg negative, first time volunteer blood donors were included in the study from blood bank, Lok Nayak Hospital, New Delhi. The blood specimens from all these subjects were evaluated for anti-HBV-core antigen (anti-HBc) serology, anti-HBV-surface antigen (anti-HBs) titres and HBeAg. The presence of HBV DNA was evaluated by testing, through polymerase chain reaction (PCR) techniques. Results: Of the 2175 HBsAg negative voluntary blood donors, 413 (19.8%) were tested to be positive for anti-HBc alone. Of these, 153 (group-I) were anti-HBs negative whereas group-II comprises a total of 260 anti-HBs positive cases i.e. 89 out of 413 had anti-HBs titres of 10-99 IU/l and the remaining 171 had anti-HBs titres of 100-500 IU/l. HBV DNA was detected in 7.5 per cent anti-HBc positive samples irrespective of anti-HBs status. Interpretation & conclusions: Our results showed that 18.9 per cent of our donor population was anti-HBc reactive, and hence inclusion of anti-HBc testing will lead to a high discard rate. The presence of HBV DNA in fairly high percentage of anti-HBc positive samples highlighted the need for a stringent and better screening system to prevent occult HBV infection.

Clinical & molecular characterization of human TT virus in different liver diseases.

Background & objectives: TT virus (TTV) is a newly discovered non-enveloped, single stranded DNA virus of high genotypic variability, found frequently in patients with acute or chronic hepatitis of non A-G aetiology. This study was carried out to look for the presence of TTV and its genotypes in patients with different types of liver diseases from northern India. Methods: A total of 262 serum samples from patients of acute viral hepatitis (AVH; n=72), fulminant hepatic failure (FHF; n=49), chronic active hepatitis (CAH; n=93) and liver cirrhosis (LC; n=48), were analyzed for hepatitis A-G viral markers. TTV DNA was detected in all cases by nested polymerase chain reaction (PCR) using the primers from N22 and untranslated (UTR) region. TTV-DNA was also tested in 150 volunteer blood donors. Direct nucleotide sequencing of N22 amplicons were carried out to look into the prevalent TTV genotypes. Results: TTV-DNA was detected in 73.6, 59.2, 21.5 and 29.1 per cent cases with AVH, FHF, CAH and cirrhosis, respectively. In AVH and FHF groups, TTV showed co-infection with all A-G hepatitis cases whereas in CAH and cirrhosis groups, TTV co-infection observed with HBV, HCV and HGV. TTV-DNA was detected in 45.3 per cent volunteer blood donors. No statistically significant difference was observed amongst the mean liver function profile of UTR PCR positive and negative cases in different liver disease groups except AVH cases, in whom the various biochemical parameters between TTV positive and TTV negative patients were marginally significant. However, no significant evidence of biochemical or histological deterioration of the liver was observed in TTV positive cases amongst FHF, CAH and cirrhosis. Predominance of genotype 1a was observed in all the cases from north India. Interpretation & conclusions: TTV is a frequent virus isolated from patients with various types of liver diseases as well as in healthy individuals from northern India. TTV has no effect on biochemical markers of associated liver diseases. Genotype 1a was the most predominant type in different liver disease groups. The occurrence of TTV did not further influence the course of the disease.

A case of primary rectal non-Hodgkin's lymphoma treated with chemotherapy.

Primary rectal non-Hodgkin's lymphoma is a rare disease. Surgery has been proposed as the primary treatment modality for colorectal lymphomas. We report a case of rectal non-Hodgkin's lymphoma (B cell large cell type, Ann Arbor Stage 1E) who responded completely to systemic chemotherapy.