Do you accept to receive a transfusion from a donor with altered liver functions? [a multinational trial]

ABSTRACT

An absolutely safe blood transfusion without infection risk is still an elusive goal and despite thorough screening facilities distrust and suspicion remain. This is even more of a challenge in areas of high endemicity of different forms of hepatitis. Therefore, in addition to evaluating the routine serologic markers [HBsAg and HCV antibody screens], we decided to study certain liver function tests [alanine transaminase [ALT], aspartate transaminase [AST], total bilirubin, alkaline phosphatase [ALP], and gamma glutamyl transferrase [GGT] in a group of 1329 serial blood donors. The donors belonged to 26 different nationalities and were all males between the ages of 18 and 60. It was surprising to record an impressively high prevalence of altered liver parameters, ranging from 14.9% for high total bilirubin up to 37.1% for high ALT. among donors of most nationalities. The incidence of HBsAg and HCV antibody reactivity among the cohort, however, was only 5% and 3%. respectively. Moreover, there was no clear association between the seroreactivity and biochemical abnormalities greater than 86% of the donors exhibiting altered liver tests were non-reactive for HBsAg or HCV antibodies, and on the other h and, completely normal liver function parameters were encountered in 28.8% of the HBsAg-positive and 22.5% of the HCV antibody-reactive population. Thus the etiology of the anomalous liver function tests in our donors is still largely unknown. After excluding donors who were reactive for HBsAg or HCV as well as those with abnormal biochemistry values we ended up with only 28.9% of the initial number of donors [384/1329]. Although the significance of altered liver function parameters in people who are seronegatiue is not yet established, it is crucial in our situation to exclude the possibility that it reflects a prevalent blood transmissible agent