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

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

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

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

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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