Low Yield From Hepatitis C Virus (HCV) Lookback At a Large Cancer Center

While chronic hepatitis due to HCV is a major health problem in the USA, blood transfusions pose a low risk of transmission. The federally mandated lookback process is initiated when a blood donor, previously negative or untested for HCV, now has a positive test. The process serves to identify any possible transmission during the “window period.” While there have been publications on lookback series from single institutions and countries, to date there has not been data presented solely from a cancer center.

Moffitt Cancer Center (MCC), a large NCI-designated comprehensive cancer center, has had 291 HCV lookback investigations. Although the average age at time of transfusion was 51, this failed to include a number of patients on whom an electronic medical record was not created. Most of the transfusion recipients had advanced age or were ill from their cancer and had died prior to the investigation, accounting for 234 (80.4%) of the cases. Five of the cases were blood components that had expired and were never transfused. Six cases identified blood components that were never received and were actually transfused at other facilities. One case had no documentation of the recipient of the fresh frozen plasma unit. Eight cases were from patients who were alive but not tested either due to patient decision or inability to get in contact with them. Out of the 37 patients that were subsequently tested, 35 (94.5%) of them tested negative for HCV by either anti-HCV enzyme immunoassays (EIA) or nucleic acid amplification tests (NAT), or both. Only 2 patients (or 0.7% of all cases investigated) tested HCV seropositive (EIA and RIBA confirmed). Both transfusion recipients were elderly women who were asymptomatic for chronic hepatitis and who posed no current or past risk for transmission via their blood or body fluids.

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In our case series, 80.4% of recipients were deceased at the time of the investigation. The seroprevalence rate in our case series, among the 37 recipients tested for HCV and transfused between 1988 and 2012, was 5.4%.

In the USA, HCV prevalence continues to be low with current estimates <1.5%. The CDC has recently expanded the recommendations for HCV testing to any persons born between 1945 and 1965, recipients of blood transfusions before July 1992, and patients with abnormal liver enzymes. Since the initiation of blood donor HCV EIA testing in 1990 and NAT testing in 1999, the risk of transfusion-transmitted HCV infection has plummeted. Given the improved public awareness of HCV, improved blood donor testing, and the low yield of the lookback process to both the recipient and society, discontinuation of the HCV lookback requirement should be considered. This case series also highlights that most transfusion recipients are either older or ill. As with HCV, several recent publications document the infrequency of transmitting human immunodeficiency virus (HIV) through modern transfusions; In England and Wales from October 1995 to December 2008, only 1 HIV positive recipient was identified with the lookback procedure.

In conclusion, our large cancer center had almost 300 HCV lookback notifications and most transfusion recipients had advanced cancer and died prior to case investigation. The series found 94.5% of recipients tested had no evidence of HCV transmission. Consideration should be given to focusing HCV detection efforts on the general public and to eliminating the HCV lookback requirement in transfusion recipients.