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

: Fu MX, Ingram J, Roberts C, Nurmi V, Watkins E, Dempsey N, Golubchik T, Breuer J, Brailsford S, Irving WL, Andersson M, Simmonds P, Harvala H

: 2024

: Vox Sanguinis

: Vox sanguinis

: Vox Sang

: 119

: 5

: 447

: 459

: 0042-9007

: 1423-0410

DOI: https://doi.org/10.1111/vox.13608

BACKGROUND AND OBJECTIVES\nMATERIALS AND METHODS\nRESULTS\nCONCLUSION\nExclusion 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.\nThree hundred ninety-seven HBV surface antigen-negative and anti-HBc initially reactive blood donor samples were tested by five different anti-HBc assays.\nEighty 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.\nUsing 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.