Blood Donors Positive for HBsAg and Negative for Anti‐HBc Antibody

Abstract. From January 1980 to December 1983,989,907 blood donations were screened for HBsAg. A total of 1,345 was found HBsAg positive; 33 of whom were negative for anti‐HBc (2.45%); in 10 cases HBeAg was present at a low level along with HBsAg. 2 of the 33 subjects were lost to follow‐up. Late serum samples were available for 28 blood donors, and clinical and biological data only were known for the 3 others. An evolution of HBV markers was observed in each case; anti‐HBc antibody became positive in 24 subjects (the 4 remaining subjects had a very short follow‐up); HBeAg was positive at a high titer in 18 subjects and seroconversion to anti‐HBe was observed in 7 individuals; HBsAg concentration increased in 21 subjects from 2 to 4,000 times and decreased in the 7 others. Seroconversion to anti‐HBs was observed in 8 individuals. According to these serological, biological and clinical findings, different outcomes were observed: in 6 subjects too short a follow‐up was available to allow appropriate classification, but there was evidence to suggest all probably developed clinical hepatitis; in 6 subjects asymptomatic hepatitis with rapid loss of HBsAg occurred; in 2 subjects asymptomatic hepatitis with the persistence of HBsAg at a low level and seroconversion to anti‐HBe occurred; and in 17 subjects clinical hepatitis developed. These observations establish that most of the 33 blood donors were infectious at the time of their blood donation, and that anti‐HBc antibody screening must not replace HBsAg screening for blood donations.