Anti HBc in Blood Donors Who Pass the Filter Test of Spread
Infections through Transfusion
Novia, Chrismis Novalinda Ginting, Linda Chiuman, and Sahna Ferdinan Ginting
Medical Faculty, Universitas Prima Indonesia ,Medan, Sumatera Utara, Indonesia
Keywords: Blood transfusion, Screening, HBV, HBsAg, Anti-HBc.
Abstract: Blood transfusion is a medical procedure that helps cure patients and even saves lives, but is at risk of
transmitting infectious diseases through transfusions. Transfused blood donors should be safe and free from
the risk of disease of Hepatitis B, HIV, Spilis and Hepatitis C by the chemiluminescence immunoassay
method. Description of anti-HBc in blood donors who passed the screening test of spread infections through
blood transfusion (SIBT) and the relationship of the HBsAg to the anti-HBc indexs were evaluated by cross
sectional method with sample of 123 respondents. The SIBT screening test results on anti-HBc show about
18.7% and 81.3% of respondents were failed and passed, respectively. Other test results showed the frequency
of anti-Hbc in blood donors with negative HBsAg of 13 respondents (13%) was declared reactive, with a
history of never having participated in hepatitis immunization before.
1 INTRODUCTION
Since 1985, efforts to safeguard the blood safety of
donors against hepatitis B virus (HBV) infection have
been tested for each bag against Hepatitis B Surface
Antigen (HBsAg) (Suryani, and Setiawaty, 2015).
Hepatitis B is inflammation of the liver caused by the
HBV virus. This virus belongs to the family
Hepadnaviridoe (Ferdianto, 2019). The hepatitis B
virus is a prototype member of the Hepadnaviridae
(hepatotropic DNA Virus) family. The Hepadna virus
has a strong preference for infecting liver cells (Don
Ganem and Alfred, 2006). But a small portion of
hepatitis DNA can also be found in the kidneys,
pancreas, and monoclear cells. Transmission of HBV
is the same as transmission of human
immunodeficiency virus (HIV) through contact with
blood or body fluids from people infected with HBV.
Besides HBV transmission can also be through blood
transfusions that are contaminated with HBV and
who often get hemodialysis (Amtarina, 2009).
Occult HBV infection is defined as the presence
of HBV DNA in blood or liver tissue in patients
negative for HBsAg but may or may not be positive
for HBV antibodies. It is possible that, donors with
occult HBV infection (which is detected to be HBsAg
deficient) have exposure to HBV infection as shown
by positive anti-HBc positive. Antibodies against
HBV nucleus antigens and HBV DNA, are also a
potential source of HBV infection (Asim, 2010).
Disguised HBV has been proposed since the
1980s, but has only been well identified during the
past 10 years after the discovery of molecular biology
techniques (Karjadi, 2015). Through observation
with electron microscopy in the serum of patients
infected with HBV can be found several types of
HBV particles. Persistence of the hepatitis B virus
genome (HBV DNA) in individuals with negative
HBsAg (hepatitis B surface antigen) is referred to as
disguised HBV infection. The possibility of occult
HBV is often found in patients with
immunosuppressed conditions induced by therapy or
diseases related to the immune system. Disguised
hepatitis B infection appears to be more related to
strong suppression of viral replication and gene
expression. Intact HBV virions are called Dane
particles. Dane particles of 40-42 nm with double
shelled usually contain surface antigens. In the
middle there is a nucleocapsid surrounded by a
protein sheath and consists of hepatitis B core antigen
(HbcAG), Hepatitis Be antigen (HbeAG), HBV
genome, and DNA polymerase (Amtarina, 2009).
Hepatitis B vaccination was given as an effort to
protect against hepatitis B infection, which can be
given at any age level from infants to adults. The
success of a vaccination can be determined based on
30
Novia, ., Ginting, C., Chiuman, L. and Ginting, S.
Anti HBc in Blood Donors Who Pass the Filter Test of Spread Infections through Transfusion.
DOI: 10.5220/0010286400300034
In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 30-34
ISBN: 978-989-758-500-5
Copyright
c
2021 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
the measurement of anti-body titers formed through
laboratory tests (Astuti and Kusumawati, 2013).
Several researchers have conducted research
related to examine issue, including Anti HBc
screening in Indian Blood Donors still an unresolved
issue that carried out by the Transfusion Medicine
Department in collaboration with the PGIMER
Hepatology Department, Chandigardh. Observations
were made for 1 year from July 2005 to December
2006 with a total sample of 1700 donors using two
methods, namely PCR and ELISA. The results
showed that the incidence of HBV DNA was low in
anti-HBc reactive samples due to the limited
sensitivity of HBV DNA amplification techniques.
Another possible reason is the low sensitivity of HBV
DNA due to the type of blood donor and disease
endemicity in the study population (Dhawan, 2008).
Anti Hb Core screening significance of healthy blood
donors in Fayoum with a total sample of 400 blood
donors using a prospective cross-sectional cohort
analysis with analysis methods using PCR and ELISA
(Abdelaziz, 2016; Turnip et al, 2020; Wijaya et al,
2019). Positive Anti HBc description was also found
in blood donors with negative HbAG with a sample
of 100 respondent using a cross-sectional descriptive
analysis and the ELISA methods (Susila, 2015).
Anti-HBc blood donor screening still varies in
different countries, where HBV prevalence is still low
(generally <2%), while it is not carried out in areas
with high HBV since the impact of anticipating anti-
HBc donors is considered unsustainable. However,
the prevalence of hidden HBV infection is higher in
areas that commonly with HBV infection. Therefore,
in some areas low antibody titers of HBC or high
titers against HBsAg (antiHBs) are used to minimize
the risk of transmission (Manzini, 2007).
Furthermore, it is necessary to conduct a study that
examines the extent of blood transfussion that is
considered HBV-free (HBsAg) which is still possible
to transmit HBV through additional anti-HBc
examination. This is not only necessary to increase
the academics knowledge, but is also needed as
material for health service policy especially to
address the problem of HBV transmission. Different
from previous studies, researchers used the
chemiluminescence immunoassay (CLIA) analysis
method in examining blood samples.
2 METHOD
The study was conducted at the Indonesian Red Cross
Blood Transfusion Unit, Batam-Riau Islands from 01
to 31 December 2019. Donors who met the general
criteria for the Blood Transfusion Unit were used in
the study. Respondent data used have passed the
scrining of spread infections through blood
transfusion (SIBT) with CLIA Architect.i.2000 Sr.
method. Architect.i.2000 Sr method is used to detect
qualitative antibodies against Hepatitis B core
antigens (anti-HbC) in human serum and plasma. The
CLIA method is a type of biochemical immunoassay
test that measures the concentration of a substance in
a liquid, in the form of blood serum or urine by
observe antibody reactions to its antigen. Serum or
plasma was used as HBsAg examination material.
The CLIA method can also used to study HIV, HCV,
HBSAG, and Siphilis in the blood of donors. The
CLIA works using derivatives of luminol with
peroxidase and H2O2 (or other enzymatic systems
that produce H2O2, such as glucose oxidase or
uricase) with enhancers (derivatives of phenols, such
as p-iodophenol) that can increase light emission up
to 2,800 times.
To observe the anti-Hbc description of donors
who have passed the SIBT examination, a cross-
sectional design of the independent and dependent
variables is used. The sample size was 123
respondents (five milliliters of blood per respondent)
with inclusion and exclusion criteria. Inclusion
criteria included being willing to become a
respondent by signing an informed consent, voluntary
and routine donors coming to the UTD PMI Batam
city, patients who met the blood donor criteria and
patients who passed the SIBT screening. While the
exclusion criteria were not passing the SIBT
screening, the voluntary donor first donated blood,
and was not willing to participate in the study.
Before doing this research, I gave a questionnaire
to potential donors who wanted to participate in this
research by filling out a questionnaire. The
questionnaire must be filled in by answering the
questions I gave. As :Have had hepatitis
immunization before ,Have a history of contact with
people with hepatitis B,Has previously been declared
cured of hepatitis B.
Summary of the respondents characteristics
included are the age of 18-24 years about 17 men and
6 women, aged 25-44 years about 5 men and 8
women, aged 45-65 years about 82 men and 5
women. History of blood donors with a frequency of
donors 20 -39 times about 25, 40-60 times about 83
donors, 61-80 times about 10 donors, and 81-100
times about 5. History with and without
immunization about 87 and 13, respectively.
Respondents with a family history who had a risk of
hepatitis were 100 and no family members were
indicated. The summary diagram of the research
Anti HBc in Blood Donors Who Pass the Filter Test of Spread Infections through Transfusion
31
process is shown in Figure 1. Figure 1 where the
donor after filling out the questionnaire and doing a
blood pressure check and blood tapping. And then
samples were taken for screening IMLTD 4
parameters. Then the sample is rotated in a centrifuge
at a speed of 4000 rpm and then the blood sample is
examined and put into a CLIA instrument. After the
results of the initial screening came out and were
declared non-reactive, the blood sample was raised
back to further tests, namely the anti-Hbc test.
Figure 1. Blood sample processing: (a) Donors who pass
the screening test of
SIBT, (b) Blood sample, (c) Centrifius
process, (d) After centrifius, (e) Insert into
CLIA system,
(f) Sample analysis,
(g) Data recording.
3 RESULTS AND DISCUSSION
Based on the screening test results of the SIBT, it was
obtained that the pass donors were 100 respondents
as shown in the Table 1. The screening test on SIBT
aims to determine which blood can be transfused with
the lowest possible transmission. The screening test
consists of several stages including HBsAg screening
test in the form of a blood test to find out whether
someone is infected with the hepatitis B virus or not.
Venereal Disease Research Laboratory (VDRL)
screening test to find out whether someone is infected
with Treponema pallidum bacteria that causes
syphilis. HIV screening test (infectious disease that
causes Acquired Immunodeficiency Syndrome
(AIDS)) is a screening procedure to detect HIV
infection in the patient's body. Hepatitis C screening
test (HCV) is an infection that attacks the liver.
Hepatitis C often does not provide symptoms, but
chronic infection can cause scarring (eskar) in the
liver, and after chronic causes cirrhosis. If the index
value <1 defined as normal and if the index value> 1
is included reactive.
Table 1: Screening Test of the SIBT.
Based on the study results, majority of donors
have the results of anti-HBc examination that non
reactive and reactive are 87 (87%) and 13 (13%),
respectively (Table 2). Infection by the virus of
hepatitis B is a public health problem and is the main
cause of morbidity and mortality especially in
developing countries. The world can be divided into
three regions based on the prevalence of HBV
infection, namely chronic: high (> 8%), medium (2-
8%), and low (<2%). Most countries in the world are
still considered moderate to high endemicity for HBV
infection. In Batam the prevalence of hepatitis B
varies from 2.3 to 2.5%, depending on various regions
of the country. Blood transfusions collected from
blood donors in the window period can cause post
transfusion of hepatitis B in recipients. At present,
HBsAg detection is the only diagnostic screening test
for HBV infection in Indonesia.
Table 2: Indeks Anti Hbc (R is respondens and r is
reactive)
HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical
32
Respondents who passed the SIb HBsAg
screening test with the CLIA method did not
necessarily not transmit the HBV virus, because from
the results of the study, 100% of respondents were
declared to have passed the HBTAg SIBT screening
test but in the Anti HbC test there were 13
respondents (13%) who had the test results reactive.
This certainly will greatly affect the transmission of
the hepatitis virus through blood transfusions. Anti-
HBc has been found as an excellent indicator for
hidden HBV infection during the window period.
Another indication for detecting HBV infection
hidden in HbsAg negative blood donors is the
detection of HBV DNA by a polymerase chain
reaction (PCR), but it is not cost-effective. Anti-HBc
detection has contributed significantly to the
reduction in the incidence of post-transfusion
hepatitis B in patients. The anti-HBc IgM class is an
indicator that shows recent infections. Variations in
anti-HBc IgG appear later during infection and point
to past HBV infection. Individuals with various anti-
HBc IgG may not transmit because they may have
antibody titers that are high enough for protective
HBsAg (anti-HBs), and affected people may actually
be free of anti-HBc disease produced in plasma
shortly after HBsAg and remain in circulation for 3-4
months. Anti-HBc can be detected using the CLIA
method, but the very sensitive CLIA method cannot
detect the presence of viral DNA from hepatitis.
4 CONCLUSIONS
Donors who have passed the hepatitis B SIBT
screening test may not be safe from spread of the
Hepatitis B virus and Indonesian Red Cross has no
core examination of the hepatitis B virus. This means
that blood discharge of the Indonesian Red Crossis
not necessarily safe for transfusion. This is supported
by the results of the study, 123 total donors who
passed the screening of hepatitis B found that 100
respondents still have the core of the hepatitis B virus
that can transmit to patients who receive blood.
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