[Transfusion and hepatitis C].

Abstract

Hepatitis C has been a major transfusionnal risk until the beginning of the 90's, since it accounted for more than 90% of non-A, non-B hepatitis, 5% to 10% of infected surgical recipients and up to 50% of multitransfused patients, alltogether 100,000 to 400,000 blood components recipients in France. The decline in incidence was based principally on sequential introduction of donor testing, starting with surrogate markers in 1988 (transaminase ALT and antibody anti-core HBc), followed since 1990 by specific assays (anti-hepatitis C virus antibodies) and on blood donor selection. Two risk factors have been identified in donors, intravenous drug use and previous transfusion. The risk of transmission was estimated, after screening by first generation tests at 1 per 1670 units transfused. After second generation testing, the risk ranged from 1 in 2000 to 1 in 6000 units transfused, corresponding to a reduction of more than 90%. The estimation of the residual risk (mean: 1/100,000 donations in USA), principally due to incidence in regular donor required mathematical calculation. The new "hemovigilance" system in France with mandatory notification of all posttransfusionnal incidents and infections will contribute to evaluate and to prevent residual cases. However, further studies are necessary to precise other risk factors in donors, as well as the role of nosocomial infections in recent cases, and possibly the role of additional agents such as GB viruses in post-transfusionnal hepatitis.