Jake Miller
Hepatitis C is a liver inflammation caused by the Hepatitis C Virus (HCV). It is usually spread when infected blood enters the body of an uninfected person. HCV is transmitted through exposure to infected blood, contaminated syringes and needles, and receipt of contaminated blood transfusions. Blood banks have implemented screening tests for blood donations to detect HCV antibodies and antigens, reducing the risk of transfusion-transmitted infections. The tests aim to minimize the risks associated with blood transfusions and ensure the safety of recipients.
| Characteristics | Values |
|---|---|
| Hepatitis C Virus (HCV) | Found worldwide; 3-4 million people infected annually; 130-170 million chronically infected |
| Transmission | Body fluids, especially blood; injecting drug use; contaminated syringes/needles; needle-stick injuries; blood transfusions; organ transplants; mother-to-child |
| Symptoms | Fever, fatigue, flu-like illness, decreased appetite, nausea, abdominal pain, dark urine, grey faeces, joint pain, jaundice |
| Testing | Enzyme Immunoassay (EIA); Nucleic Acid Testing (NAT); HCV antibody and RNA tests; CDC recommends universal screening for adults over 18 and pregnant women |
| Blood Banks | Red Cross screens blood donations for multiple diseases, including HCV antibodies |
| Treatment | Direct-acting antivirals; no vaccine available |
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What You'll Learn
Hepatitis C virus (HCV) is transmitted through infected blood
Blood is routinely tested for various infectious diseases, including the Hepatitis C Virus (HCV). HCV is transmitted through infected blood and is one of the most common viruses that infect the liver, causing hepatitis, or inflammation of the liver. It is estimated that 3–4 million people are infected with HCV each year, and 130–170 million people are chronically infected worldwide.
HCV is transmitted when infected blood enters the body of someone who is not infected. It is commonly spread through injecting drug use, contaminated syringes and needles, and needle-stick injuries in healthcare settings. It can also be transmitted through contaminated blood transfusions, blood products, or organ transplants. The risk of contracting HCV through blood transfusion has decreased significantly due to the implementation of nucleic acid testing (NAT) and the availability of direct-acting, highly active anti-virals. The per-unit risk of HCV infection through blood transfusion is now less than 1 per 2 million units screened.
Blood donation centres, such as the Red Cross, screen blood donations for multiple disease markers, including HCV antibodies. Initial screening tests for HCV utilised enzyme immunoassay (EIA), which had a long infectious window period. More advanced assays, such as the fourth-generation HCV antigen and antibody assay (combination EIA), detect two infectious markers of HCV in the same assay. Molecular testing for HCV-RNA using nucleic acid amplification technology (NAT) is the most sensitive assay, reducing the window period to only 4 days.
The implementation of NAT has significantly reduced the risk of transfusion-transmitted HCV in many developed countries. However, in resource-constrained countries, HCV screening methods vary depending on infrastructure, trained personnel, and financial resources. Rapid tests that are simple to perform are often used in small and remote blood centres, although they may be less sensitive than EIAs. The CDC recommends universal hepatitis C screening for all adults over 18 and pregnant women during each pregnancy to prevent complications and interrupt transmission.
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Blood banks use antibody tests to detect HCV
Blood banks use antibody tests to detect Hepatitis C Virus (HCV) antibodies in donated blood. HCV is a common virus that infects the liver and can cause hepatitis, or inflammation of the liver. It is usually spread when blood from an infected person enters the body of someone who is not infected. As there is a risk of transmitting HCV through blood transfusion, it is essential to screen donated blood for the virus.
Enzyme immunoassay (EIA) for HCV antibodies was the initial screening test introduced for blood donations. The first-generation EIA detected seroconversion after a long infectious window period. Improved HCV antibody assays reduced the window period to around 66 days. However, HCV core antigen EIAs further shortened this period, but their high costs prevented widespread acceptance.
To enhance the sensitivity and efficiency of HCV detection, a fourth-generation HCV antigen and antibody assay (combination EIA) is often used. This combination assay detects two infectious markers of HCV simultaneously, making it more convenient and effective. Molecular testing for HCV-RNA using nucleic acid amplification technology (NAT) is the most sensitive assay, reducing the window period to only 4 days. NAT has significantly reduced the risk of transfusion-transmissible HCV, with the relative risk now less than 1 per million donations in many developed countries.
The Ortho HCV ELISA test is commonly used for the qualitative detection of HCV antibodies in human serum or plasma samples. If a donor's sample tests positive for HCV antibodies but negative for NAT, further testing is performed. False-positive donors may be re-entered, and it is important to repeat the virus test to confirm the presence or absence of the infection.
Overall, blood banks utilise a combination of antibody tests and nucleic acid amplification technology to detect HCV in donated blood effectively. These tests play a crucial role in ensuring the safety of blood transfusions and minimising the risk of HCV transmission.
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Nucleic Acid Testing (NAT) is used to detect HCV RNA
Blood banks routinely test for infectious diseases, including hepatitis C (HCV). Hepatitis C is a blood-borne virus that infects the liver and can cause hepatitis, or inflammation of the liver. It is usually spread when infected blood enters the body of an uninfected person. It is most commonly transmitted through exposure to infected blood, such as through injecting drug use, contaminated syringes and needles, and blood transfusions.
The implementation of NAT for HCV RNA has significantly reduced the window period from infection to detection. Previously, antibody tests were used to screen for HCV, but these tests only indicate a previous or current infection. In contrast, NAT detects the presence of the virus itself in the blood. This distinction is crucial because about 70% of people infected with HCV become persistently infected, while about 25% may spontaneously clear the virus within 12-14 weeks.
When an individual tests positive for HCV antibodies, doctors or laboratories will automatically perform NAT for HCV RNA to determine if the person is actively infected. A positive NAT result confirms a current infection, while a negative result indicates a previous infection that is no longer present in the body. NAT allows for more accurate and timely diagnosis, enabling prompt treatment initiation.
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False-positive donors can be re-entered for blood donation
Blood banks employ a two-stage method for screening blood donations for infectious diseases. The first stage is a quick and sensitive screening test to identify blood that can be used for transfusion. The second stage involves additional testing, which is more time-consuming and is only performed on donations that produce positive results in the first stage to determine if those results are false or true positives.
The Red Cross Blood Services in the US states that false-positive donors for any HBV marker may be re-entered. Similarly, false-positive donors by either antibody or HCV NAT may be re-entered. The per-unit risk of HCV infection through blood transfusion is less than 1 per 2 million units screened as of 2019, but this number is currently much lower due to the availability of direct-acting, highly active anti-virals.
Canadian Blood Services also has a donor re-entry program for donors who have received a false positive test result. After six months, these donors are asked to call a helpline to speak with a health professional about getting re-tested. At the re-testing appointment, a small amount of blood is collected for testing, and a follow-up letter is sent to advise the donor of their results. If all results are negative, the donor may be able to donate again.
It is important to note that if a false positive test occurs a second time, the donor will no longer be eligible to donate blood.
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HCV infection risks include injecting drugs and contaminated syringes
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV) that can lead to chronic infection, causing cirrhosis, liver cancer, liver failure, and even death if left untreated. HCV is found worldwide, and it is estimated that 3–4 million people are infected with HCV each year. The virus is transmitted through contact with infected blood and is most commonly spread through injecting drugs, with contaminated syringes and needles, and needle-stick injuries in healthcare settings.
People who inject drugs, even those who have injected occasionally or many years ago, are at an increased risk of HCV infection. This is because the virus can remain on syringes and needles, as well as on inanimate surfaces for weeks. Sharing needles and syringes, as well as other drug preparation equipment, increases the risk of HCV transmission. Injecting drugs is the most common way HCV is transmitted in the United States, and community-based prevention programs can help reduce this transmission. These programs include medication-assisted treatment and syringe services, as well as scaled-up needle/syringe distribution and access to HCV treatment.
In addition to injecting drugs, HCV can also be transmitted through other means, including receiving contaminated blood transfusions, unregulated tattoos or body piercings, and sharing personal items contaminated with infected blood. Transmission can also occur from an infected mother to her child during birth. While less common, sexual transmission of HCV can also occur, especially among individuals with multiple sex partners and men who have sex with men.
To prevent HCV infection, it is crucial to avoid behaviours that can spread the disease, especially the use of non-sterile injection equipment. Safe and effective treatments, known as direct-acting antivirals or DAAs, are available for HCV and can cure the infection in almost everyone who takes them. These treatments have few side effects and do not require injections. Regular hepatitis C testing is recommended for people with ongoing risk factors, and one-time universal screening is advised for all adults aged 18 and older, as well as pregnant women during each pregnancy.
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Frequently asked questions
Yes, blood banks do test for Hepatitis C virus (HCV) antibodies.
Blood banks use enzyme immunoassays (EIAs) for initial screening. More advanced methods include nucleic acid testing (NAT) and molecular testing for HCV-RNA.
Hepatitis C is transmitted through infected blood and affects the liver. Testing donations help prevent the spread of the virus and ensure safe blood supply for transfusions.
A positive result indicates a current Hepatitis C infection. Counselling, evaluation, and treatment initiation are recommended. False positives may occur, and further testing may be required.
