Low-Risk Of Hepatitis-B In Thalassemia Major - Implications For The Use Of Hepatitis-B Vaccine In Connecticut

Active immunization with the HB vaccine is advocated for patients receiving frequent transfusions of blood or blood products, including hemophiliacs and thalassemics. We have diagnosed HB in our hemophiliacs who receive pooled plasma concentrates but not in thal major patients who receive 15/ml/kg of washed, leukocyte-poor RBC every 3-5 weeks. Blood from 25 thal major patients was tested for HBs Ag, anti-HBs, anti-HBc, and also for EBV-VCA and CMV-CF. All bloods were negative for HBs Ag. Two of 25 had anti-HB. One of these was an immigrant Greek boy who had anti-HB when he came to CT. The other patient converted between 1981-82 but had no symptoms of hepatitis. The percent positive and range of titers against CMV and EBV were similar to normals. These patients receive 800 units of RBC every year and have been exposed to about 10,000 units of blood during the past 17 years. Thus the risk of developing anti-HB (= exposure) in CT appears to be of the order of 1/10,000 units transfused. The probability of developing clinical HB is much less. Reasons for this very low risk include: 1. Use of wholly volunteer blood in CT for 20 years. 2. Routine screening of all blood for HBs Ag for 9 years. 3. Use :of washed, leukocyte-poor blood. Because of the low risk of HB exposure, the need for HB immunization of thal major patients in CT is dubious. Similar procedures should be effective in reducing the risk of other transfusion related diseases, including non-A, non-B hepatitis and HTLV III related AIDS.