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Hepatitis C alert - delay elective surgery.

Hepatitis C is spread through the exchange of body fluids in sexual activity and through blood transfusions. It is the most common form of hepatitis spread by transfusions. About 50 percent of those infected with the hepatitis C virus develop chronic hepatitis, marked by jaundice, fatigue, nausea, and potential liver damage, and about 20 percent eventually develop cirrhosis of the liver. The virus has also been linked to an increased risk of liver cancer.

The danger of spreading hepatitis C is the long incubation period when persons are infectious but not sick. It's not like hepatitis A, in which the patient gets quite sick within a couple of days after being infected and goes for treatment. Hepatitis C carriers can have no symptoms. Dr. Brooks Jackson, clinical pathology director at University Hospitals of Cleveland, says that one in 100 or one in 200 people has antibodies to the hepatitis C virus, depending on what part of the country you're in. The incidence is higher on the coasts than in the Midwest. Dr. Jackson, who has worked in blood banking for a long time, spoke with us recently.

"They've been testing for hepatitis C for over a year now all over Western Europe. The tests are being shipped to Canada, Australia, and Japan, but the FDA still hasn't licensed it here and it's very serious. One in 200 donors is infected. It's going to be a real surprise to a lot of people, I think. And it's a bad disease," Dr. Jackson said.

"Many people are currently calling for postponement of all elective surgery until the test is available, and putting pressure on the FDA. It's a big controversy right now. [The manufactured test] isn't licensed for blood-bank testing," Dr. Jackson said. "So the companies won't sell it to you for that. Also, we have another problem. If we get our blood from the Red Cross, and the Red Cross isn't testing and we go ahead and test it and come up with positive blood, part of the problem is we haven't gotten the informed consent of the donors to test them for hepatitis, because they're not our donors.

"Then we can't test our donors but not [also test] the blood from other sources and give some of our patients tested blood and some of them untested blood. So it gets to be real sticky. There is always the concern about getting into a lawsuit."

Asked whether a person can choose to have blood for a transfusion flown over from Europe, where the test is used extensively, Dr. Jackson said he didn't know. "If you're going to have five units of blood for open-heart surgery, [the risk] multiplies times five," he said. "Then, typically, you may get ten units of platelets afterwards for open-heart surgery, so that's 12 to 15 exposures-so your risk really does increase."

Asked when the ordinary patient begins showing signs of hepatitis C after surgery, Dr. Jackson said, "It's symptomatic usually within six months. People may not get sick but develop chronic hepatitis, which can be discovered when liver biopsies are done. If they go long enough they'll get cirrhosis or liver cancer, so it's turning out to be much worse than everybody thought. Jay Menitove, who's head of the transfusion-transmitted-disease committee [of the American Association of Blood Banks] has called for postponement of elective surgery until the test is available.

"But a lot of people don't have the option of waiting for surgery. This is sort of like going back to the AIDS thing again [early days of no AIDS testing]. Everyone is just not saying much about it. But everybody knows that one out of 200 units is infectious for hepatitis C right now-we know this from the European data [where they are testing], and clinical trials done in this country. They know that that's true in this country. Between one in 200 and one in 100. These are healthy volunteer blood donors-healthy people who denied being in any risk groups or anything!"
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Title Annotation:medical test kits not licensed yet by FDA
Publication:Medical Update
Date:Mar 1, 1990
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