Blood donation screening for hepatitis B virus core antibodies: the importance of confirmatory testing and initial implication for rare blood donor groups

Fu, Michael X ORCID: https://orcid.org/0000-0002-3108-7917, Ingram, Jennifer, Roberts, Courtney, Nurmi, Visa, Watkins, Emma, Dempsey, Nina ORCID: https://orcid.org/0000-0003-2013-6207, Golubchik, Tanya, Breuer, Judith, Brailsford, Su ORCID: https://orcid.org/0000-0003-2856-0387, Irving, William L ORCID: https://orcid.org/0000-0002-7268-3168, Andersson, Monique ORCID: https://orcid.org/0000-0003-0619-1074, Simmonds, Peter ORCID: https://orcid.org/0000-0002-7964-4700 and Harvala, Heli ORCID: https://orcid.org/0000-0001-9154-4190 (2024) Blood donation screening for hepatitis B virus core antibodies: the importance of confirmatory testing and initial implication for rare blood donor groups. Vox Sanguinis, 119 (5). pp. 447-459. ISSN 0042-9007

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Abstract

Background and Objectives Exclusion of blood donors with hepatitis B virus (HBV) core antibodies (anti-HBc) prevents transfusion-transmitted HBV infection but can lead to significant donor loss. As isolated anti-HBc positivity does not always indicate true past HBV infection, we have investigated the effectiveness of confirmatory anti-HBc testing and the representation of rare blood groups in anti-HBc-positive donors. Materials and Methods Three hundred ninety-seven HBV surface antigen-negative and anti-HBc initially reactive blood donor samples were tested by five different anti-HBc assays. Results Eighty percentage of samples reactive in Architect anti-HBc assay were positive by the Murex assay and anti-HBc neutralization. Eleven out of 397 samples showed discordant results in supplementary testing from the Murex confirmatory test result, and five remained undetermined following extensive serological testing. Thirty-eight percentage of anti-HBc-positive donors identified as minority ethnic groups compared with 11% representation in anti-HBc-negative donors (p < 0.0001); the frequency of the Ro blood group in anti-HBc-positive donors was 18 times higher in non-white ethnic groups. Conclusion Using two anti-HBc assays effectively enabled the identification of HBV-exposed and potentially infectious donors, their deferral and potential clinical follow-up. However, the exclusion of confirmed anti-HBc-positive donors will still impact the supply of rare blood such as Ro.