P60
RISK OF HEPATITIS C VIRUS (HCV) INFECTION IN MULTIPLY TRANSFUSED PREMATURE
NEONATES
Beeby PJ,* Spencer J
†
and Cossart Y # .
* Department of Neonatal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050
† A W Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050
# Department of Infectious Diseases, University of Sydney, NSW 2006
Background: Reports from around the world indicate that multiply transfused patients are at increased risk of
HCV infection, with reported rates varying between 5 & 90%. Such reports mostly focused on haematological and renal patients. As recipients of blood products in the newborn period, premature infants share this risk, but no report of them having been studied has appeared in the literature.
Aim: To assess the risk of HCV infection in children who, as premature neonates, received multiple blood products prior to the introduction of screening of donated blood for HCV.
Methods: Premature infants born between January 1985 and January 1990 who had attended our high-risk follow-up clinic were selected on the basis of the number of transfusions of blood, platelets or FFP they received in the newborn period. Ethical approval to offer HCV testing to parents was obtained from the Central Sydney Area
Health Service Ethics Review Committee. Parents of infants who received 3 or more transfusions were then contacted by mail with the approved letter explaining the study, and offered HCV testing.
Detection of anti-HCV antibodies was undertaken using second, and later third generation ELISA immunoassay kits. Samples which were found to be "indeterminant" were tested using a Wellcozyme HCV western blot assay.
HCV RNA was detected using an "in-house" PCR assay. ALT was also measured, with values above 55U/L considered abnormal.
Results: Consent was obtained for 45 children, with 25 males and 20 females. The mean (± SEM) gestational age and weight of the children at birth was 26.7 ± 0.2 weeks and 938 ± 27 grams respectively. The children received 198 transfusions of blood products, an average of 4.4 units/child. This may have been an underestimation, as it seemed probable from inspection of the medical records that transfusions of FFP were not well been documented.
The median age at testing was 7 years (range 6 to 10).
All of the infants except for one were negative for anti-HCV antibodies. One infant was "indeterminant" (low positive on 3rd generation test but negative on 2nd generation test), but proved negative subsequently on both western blot and PCR testing. HCV RNA was not detected in any of the infants on PCR testing. All of the samples had normal ALT values, the mean being 16 U/L (range 8 to 52).
Conclusion: None of the children consenting to this study had evidence of current HCV infection. This may be attributed to various factors, including: (i) sample size, (ii) recovery from infection by the time of testing, (iii) selection of blood: rejection of CMV positive units may have reduced the risk of infection, and use of pedipacks may have limited exposure, and (iv) treatment of blood - does irradiation for GVH sterilise HCV? We are not able to estimate the true risk of infection from this study, except that the upper limit for the risk is about 1/200 per transfused blood sample.