They don't want my blood anymore

[davefoc]

I have been an occasional blood donor for many years. Principally because my wife guilts me into it.

The Redcross has been rejecting her blood for a long time because it falls just below the iron level they require. So my wife has pushed me to donate to compensate and after six months or so the guilt finally builds up to the level where I give blood.

So after my last trip I was surprised to get a letter from them telling me they don't want my blood either. Apparently they have a test for hepatitis B that came up positive.

According to the letter it is very unlikely that I have hepatitis B because several other tests came back negative, but out of an abbundance of caution and to comply with the federal government guidelines they have informed me that they don't want my blood anymore.

My test results:
Hepatitis B Surface Antigen (HBsAg. EIA) - POS

HBsAG Confirmatory Test (neutralization) - NEG

Antibodies to Hepatitis B Core Antigen - NEG
(anti-HBc, IgG and IgM)

Antibodies to Hepatitis C Virus - NEG
(anti-HCV, EIA)

HTLV-I/II Antibodies (EIA) - NEG


EIA= enzyme immunoassay

Anyway, I thought here and see if anybody has any comments.

[This Guy]

They don't want mine either.

I used to work in a Dialysis clinic, as an equipment tech. Had to work around a lot of blood, and patients that had Hepatitis. As a safe guard, we were given a series of shots to build up our immunity to one (or more) flavor of Hep (C I think, but could well be wrong). As a result, when my blood is tested I show the antibodies for Hep. Normally that means you had the disease. As a standard safeguard for the blood supply, they don't want mine.

Please excuse any bad terminology used. Remember, I was an equipment tech, not a doctor ;)

Kinda sucks, but does give me an excuse to not get stuck with needles, something I really hate, but was willing to do for the good of others.

As a funny aside, my first day at work, I was asked to show my behind (literally) to one of the nurses, so she could start the shots. What a way to introduce your self to your co-workers :eek:

[casebro]

They want to make sure they don't bleed your wide dry. Perhaps she could donate once a year? or post menopause?

They don't want mine. My blood pressure is to high. Now, we know that one side effect of donating is that it lowers B.P. Go figure...

[Piscivore]

They don't want mine. My blood pressure is to high. Now, we know that one side effect of donating is that it lowers B.P. Go figure...

They don't want mine for the same reason. Presumably, it's because of the hormones that control vessel dialation that are out of whack in our blood, not to mention the compensatory pharmaceuticals.

[Lamuella]

I lived in the UK for 24 years, so they don't want my blood either.

[The Painter]

They didn't want my blood for one year after going to Haiti.

[BlackCat]

I'm not surprised. It might not be a bad idea to talk it over with your doctor, but most likely, it's a false positive. I had plenty of donors complain and plead with me to let them donate again, even after they had batteries of tests that showed that they didn't have the disease. It's just their policy, and they're not going to change it. For what it's worth, I'm sorry. If you still feel like you need to help, why not organize a blood drive at your work or something? Or better yet, tell your wife to organize a blood drive.

About your wife, there's probably nothing wrong with her. I denied women all the time for low iron. (And very rarely, men.) I don't know what her diet is, but she could try eating foods high in iron, or cook food in cast iron pots and pans. Also, this is a bit anecdotal, but women would be denied more often during or the week after their period. Also, tell her to just keep trying, and not to take it personally.

BlackCat

[skeptigirl]

That result represents a false positive but you should repeat the test once to confirm it wasn't an early positive test. Also have them add hepatitis B surface antibody, unless you have been vaccinated in which case a positive won't add any information in this case. Have them include the IGG and IGM. Those are the earliest antibodies to show up and they disappear soonest which is why I say to add the hep B surface antibody.

EIA screening tests essentially are cheaper and easier to run so we do those for lots of antibody tests. But they are less specific. Other antibodies unrelated to the one being tested for can cause a cross reaction and give a false positive. So the confirmation test is reliable and if negative, the screening test is a false positive and you shouldn't worry anymore about it.

The reason I say get one re-test is lab errors can occur with any test. With something as serious as hepatitis B, you want to be sure the confirmation test was truly negative, and not negative because you were newly infected and very little virus was present. THIS IS EXTREMELY UNLIKELY so don't start worrying about that unless you have reason to think you've been exposed in the last few months.

The fact the core antibody was negative rules out past or longstanding infection with a low viral titer. When one is infected, antigen is detected first, then IGG and IGM, then surface antibody, then core antibody over a period of 2-6 weeks. Core antibody remains. Surface antibody remains most of the time and a person who was vaccinated but never infected will only have surface antibody.

Only people with antigen are contagious and risk long term liver damage and/or liver cancer. ~85% of those infected clear the virus on their own and are immune and never ill with it again. The other ~15% get acutely ill, some die, some recover, OR, they develop a carrier state. Carriers are more likely to have not had a severe illness when initially infected.

The reason the blood bank will no longer take your blood is from a policy developed after they failed to use hepatitis B core antibody to reject blood when HIV emerged. The policy then changed to exclude donors who were not carriers but who had what was considered a marker for other potential but as of yet unknown bloodborne diseases. I'm surprised they would reject a false positive unless you had the same result with a previous donation which they did not inform you of. You should ask because that would count as your second test and you wouldn't need another one.

I have had nurses donate blood but not be told until the second donation that they had B core antibody meaning past infection. The issue for a nurse to hear this is to wonder how one got infected after being vaccinated and having no exposure. Because to the nurse getting the letter, it looks like the infection occurred between donations. This is how I learned about the blood bank not sending the letter until the second positive test. It seemed like a very stupid policy to me.

One, you couldn't be sure the person would donate again so you miss the chance to inform them. The blood bank wasn't thinking about all the issues. While the donating person may not be ill, when I have a person test positive for past hep B infection, I suggest siblings and parents also be tested since the infection came from somewhere. Usually with the nurses it is from a foreign country they were born in which has high rates of hep B. If the nurse was infected from her mother, then the parents and siblings might be carriers and not know it.

The other reason the blood bank's policy of notifying on the second test is a bad policy is for exactly what happened to the nurses. They assumed the infection was between donations and of course one receives the letter arriving home in the evening and the blood bank is closed so you can't call and ask what is going on.

Nuff ranting.

If you have any other questions I'll be happy to answer them or find a reference.

[Miss Whiplash]

I was a lab technician for Serology in days of yore. You have a false positive for Hep B. Get retested and then give blood at will.

[davefoc]

Blackcat,
I didn't receive any quantitative test results. Do you think they would provide them if I asked? Any thoughts about why they wouldn't included the quantitative results with POS/NEG results?

[Miss Whiplash]

From what I remember, the test is very general at the Red Cross. False positives happen when the tests are not specific.

For instance, when I did AIDS tests for DOD, we used ELISA. If it came back positive, we did a Western Blot. A Western blot was more accurate and protien specific.

[Ducky]

They have a very good reason for not wanting my blood anymore. My cancer is in white platelet cells in the marrow.

However, getting them to realize this took 6 months of their harassing calls, and a rather long call where a nurse had to consult a doctor twice.

Oh well.

[skeptigirl]

I was a lab technician for Serology in days of yore. You have a false positive for Hep B. Get retested and then give blood at will.You can't give if they won't receive dear. It isn't up to the patient.

[skeptigirl]

Blackcat,
I didn't receive any quantitative test results. Do you think they would provide them if I asked? Any thoughts about why they wouldn't included the quantitative results with POS/NEG results?They aren't needed in this case. They will not give you any additional relevant data.

[skeptigirl]

From what I remember, the test is very general at the Red Cross. False positives happen when the tests are not specific.

For instance, when I did AIDS tests for DOD, we used ELISA. If it came back positive, we did a Western Blot. A Western blot was more accurate and protien specific.EIA and ELISA are the same test.

Here's a nice list if you want to know what the initials stand for on all these tests. (http://www.specialtylabs.com/tests/methodology.asp)

RIBA and Western Blot are essentially the same tests as well though HIV confirmation test is usually called Western Blot and the Hep C confirmation test is called a RIBA.

[Miss Whiplash]

You can't give if they won't receive dear. It isn't up to the patient.

If it's a false positive there's no reason not to give. And there are other places than the Red Cross, honey.

[Miss Whiplash]

EIA and ELISA are the same test.

I know. I was making an example of testing methods for AIDS. ELISA was less accurate than a Western Blot.

[skeptigirl]

Blackcat,
I didn't receive any quantitative test results. Do you think they would provide them if I asked? Any thoughts about why they wouldn't included the quantitative results with POS/NEG results?Forgot to add, qualitative tests (pos/neg) and quantitative tests (number result) are different tests. They didn't likely do a quant. test. And, they have a few rules about giving people results to discourage people from donating blood in order to get test results.

[skeptigirl]

If it's a false positive there's no reason not to give. And there are other places than the Red Cross, honey.Hey, you're preaching to the choir. But rules are rules in this case.

Where besides the Red Cross do they have a different standard? It's Puget Sound Blood Center here and they have the same rules.

I'm not a blood bank person so here is a better reference than my brain: FDA standards reference page. (http://www.fda.gov/Cber/faq/bldfaq.htm)

[Miss Whiplash]

EIA and ELISA are the same test.

Here's a nice list if you want to know what the initials stand for on all these tests. (http://www.specialtylabs.com/tests/methodology.asp)

RIBA and Western Blot are essentially the same tests as well though HIV confirmation test is usually called Western Blot and the Hep C confirmation test is called a RIBA.


Ummm...re-read my reply. I know what the intials stand for. There's no need to be insulting. I'm meerly stating false positives happen, not trying to refute what you are saying.

[Miss Whiplash]

Hey, you're preaching to the choir. But rules are rules in this case.

Where besides the Red Cross do they have a different standard? It's Puget Sound Blood Center here and they have the same rules.

Excuse me for even responding.

[skeptigirl]

Ummm...re-read my reply. I know what the intials stand for. There's no need to be insulting. I'm meerly stating false positives happen, not trying to refute what you are saying.The list wasn't for you, it was for everyone. You're taking my posts the wrong way. You have an unnecessary chip on your shoulder. Nothing negative was intended.

[Miss Whiplash]

The list wasn't for you, it was for everyone. You're taking my posts the wrong way. You have an unnecessary chip on your shoulder. Nothing negative was intended.

Then I apologize. One of the drawbacks of forums is we cannot see how someone is delivering their reply. However, I never have an unnecessary chip on my shoulder. I've found them all necessary at some point.

[Beerina]

I lived in the UK for 24 years, so they don't want my blood either.

I, too, "lived in Europe for at least 6 months after 1989", or whatever the rule is, so I cannot give blood, either.

I had a tough time tracking down the reason: mad cow disease!

Yes, that's right, they're worried about prions being in our blood. Prions, the newest addition to the germ theory of disease.

[epepke]

Many years ago, a sample of my blood tested for Hep B as well. So I couldn't donate for a year or two. Then they sent me a letter saying that, if I hadn't seroconverted, I could donate again.

It turned out that there was a problem with their testing equipment, and a bunch of samples tested with false positives.

[Soapy Sam]

Under UK rules, we can't donate within 28 days of visiting Canada or the USA.
West Nile Virus.

It can only be a Jungian Synchronicity that the Glasgow Blood Bank is in Nelson Mandela Suare, just off West Nile Street.

[Dragonrock]

They didn't want my blood for one year after going to Haiti.

I've been banned for life after going to Haiti and wandering around a swamp for 4 hours after NOT taking the malaria prevention drugs because I was told that I wasn't going into the swamp.

[Hydrogen Cyanide]

For a while they did not want my blood because I had lived in the tropics less than three years before. After that time and I had not shown any symptoms of malaria, I was eligible to give blood (something I need to do next week).

[Roadtoad]

They don't want mine either. I lived in Germany for 7 years. Go fig.

[This Guy]

They don't want mine either. I lived in Germany for 7 years. Go fig.

Germany for 7 years! You don't have blood! You have beer!;)

[elaine]

I've been a regular donor for several years....just got a tattoo last week. Now I have to wait a year.

At least I feel comfortable, the artist was a nut about sterilization.

[davefoc]

skeptigirl,
It was a bit surprising to me that I couldn't find any detailed information about the tests on the internet.

I don't have much experience looking for medical information, perhaps the info I was looking for is only available on paid sites?

I was also interested in the idea that the tests would not have numerical data available. What is the nature of the test such that it wouldn't have a number associated with the result at some point?

As to the suggestion that I should get retested and they might take my blood if the result came back negative :
Not according to the letter I got. I think they made it pretty clear that they didn't want my blood from here on out unless something changed in their procedures with regard to this kind of test results.

As to the idea I might really have Hepatitis and I should be retested to make sure I don't:
I'm not in any of the risk groups. I am very healthy for a 56 year old guy and I just am not going to worry about this, even to the point of getting another test.

I was curious about the test but so far I haven't found any detailed information about the test and the only things I know about it are from what skeptigirl has said and from the little bits of info supplied by the Red Cross designed to convey the minimum amount of information to put forward the idea that they don't really think you're sick.

[skeptigirl]

Taking any lab test you will find a rate of false positives called specificity and a rate of false negatives called sensitivity.

Specificity: The chance a positive is false
Sensitivity: The chance of missing a positive

I don't know which tests were used at your blood bank but here is one example of an HBsAG EIA test. Just as with drugs, there are reagent inserts and reports like this one.

ETI-MAK-4 HBsAG EIA (Product code: N0019); pdf file (http://www.hpa-midas.org.uk/documents/reports/HBsAg/MDA_01121%20ETI-MAK-4.pdf)
Reports false positive rate of 0.2% (95% confidence interval 0-1.1%)

Such reports tell the provider how accurate the tests are and one can add a bit more for operator or equipment error as well.


As far as the number, lots of tests only give a yes or no. They are called qualitative tests. Look at an over the counter pregnancy test for an example. You are either pregnant or you aren't.

Quantitative tests are ordered for many reasons but you don't always need them and they are not always done. Qualitative tests have a threshold which will give you a positive result. When I order hep B vaccination tests, I order Quantitative because it has to be >10 to tell me the vaccine worked. But if I am testing a person who was exposed, I only test for the presence or absence of core antibody. I don't care how high the level is.


The reason you could not find the information you sought wasn't because you had to pay, it was because a search for hep B tests or false positive tests gets you the million hep B information pages for the average inquiry.

Had you done a more specific search knowing to look more for lab test specifics, you would have gotten stuff like the following from Pubmed which hardly makes sense to me so I doubt it would have helped you either. These happen to be abstracts about the confirmation test rather than the screening test but I went from these to the find the above link in my quest for something useful for you.

Vox Sang. 2002 Jan;82(1):15-7.

Hepatitis B vaccinees may be mistaken for confirmed hepatitis B surface antigen-positive blood donors.

Dow BC, Yates P, Galea G, Munro H, Buchanan I, Ferguson K.

SNBTS Microbiology Reference Unit, West of Scotland Transfusion Centre, Glasgow, UK. brian.dow@snbts.scot.nhs.uk

BACKGROUND AND OBJECTIVES: Hepatitis B surface antigen (HBsAg) test sensitivities have gradually increased, and neutralizable weak HBsAg-positive donations, with no other hepatitis B virus (HBV) markers, have occasionally been found in our donor population. On investigation, these donors have admitted to receiving hepatitis B vaccine up to 5 days previously. A study was therefore initiated to monitor HBsAg reactivity amongst volunteers after receiving their first dose of hepatitis B vaccine. MATERIALS AND METHODS: Eight volunteers were tested using three HBsAg assays (Abbott Auszyme, Ortho HBsAg-3 and Abbott/Murex GE34/36) on days 0, 3, 5, 7 and 10 after administration of hepatitis B vaccine. RESULTS: Two HBsAg tests (Abbott Auszyme and Ortho HBsAg-3) did not detect HBsAg reactivity amongst the volunteers, although the Abbott Auszyme test results reached 70-80% of the manufacturer's cut-off at day 3 in two volunteers. The most recently launched assay (Abbott/Murex GE 34/36) detected seven (87%) of the eight volunteers as HBsAg reactive on day 3, and two (25%) volunteers were still reactive on day 5. CONCLUSION: The Abbott/Murex GE 34/36 assay demonstrated HBsAg reactivity in most volunteers on day 3 and in some on day 5 after vaccination. It is therefore recommended that individuals who have recently been vaccinated with hepatitis B be deferred from blood donation for at least 7 days.

PMID: 11856462 [PubMed - indexed for MEDLINE]


Clin Chem. 2006 Jun 8; [Epub ahead of print]

Performance of a New-Generation Chemiluminescent Assay for Hepatitis B Surface Antigen.

Chen D, Kaplan LA.

Department of Pathology, New York University, School of Medicine, Clinical Chemistry Laboratory of Bellevue Hospital, New York, NY.

BACKGROUND: The usual criteria for analysis of hepatitis B surface antigen (HBsAg) are detection of HBsAg and result confirmation by antibody neutralization. We observed that with the Immulite 2000 HBsAg assay [Diagnostics Product Corporation (DPC)] a relatively high percentage of weakly reactive (WR) samples did not pass the neutralization step. METHODS: For each of 3 lots of Immulite 2000 HBsAg reagent (DPC), we collected and analyzed HBsAg data from approximately 3000 to 4000 patient blood samples and compared these data with HBsAg data from 3393 samples tested with the Abbott Auszyme assay. For 127 samples with initially WR detection signals (relative signal/cutoff index of 1.00-2.5) on the Immulite 2000 HBsAg assay, we then measured hepatitis B (HB) viral load and/or other HB serologic markers. RESULTS: The Immulite 2000 HBsAg assay produced more initially reactive results than the Abbott Auszyme method. Many of these reactive samples, however, were WR and did not meet the confirmation criteria in the neutralization test. Moreover, DNA PCR testing indicated that 22 of the 38 WR samples (58%) that did meet the confirmation criteria had no detectable HB viral DNA. CONCLUSIONS: Immulite 2000 HBsAg assay results include a unique group of WR samples that are associated with both false-positive and false-negative results, regardless of neutralization status, and require careful interpretation. WR HBsAg samples should be reported as confirmed HBsAg reactive only if the samples not only meet the neutralization criteria but also are positive other HB serologic markers such as anti-HB core total and anti-HB core IgM.

PMID: 16762998 [PubMed - as supplied by publisher]


J Virol Methods. 2006 Jul;135(1):109-17. Epub 2006 Mar 29.

Evaluation of a new automated assay for hepatitis B surface antigen (HBsAg) detection VIDAS HBsAg Ultra.

Weber B, Van der Taelem-Brule N, Berger A, Simon F, Geudin M, Ritter J.

Laboratoires Reunis, Junglinster, Luxembourg, Germany. web@labo.lu

In a multicenter study a new automated screening assay, VIDAS HBsAg Ultra (long (L) and short (S) incubation protocol (Biomerieux, Marcy l'Etoile, France), was compared to a well established test (AxSYM HBsAg v2, Abbott Diagnostics, Wiesbaden, Germany) for the detection of hepatitis B virus (HBV) surface antigen (HBsAg). A total of 32 seroconversion panels, sera from the chronic phase of infection, dilution series of the WHO standard, S gene mutants (recombinant mutants and diluted and undiluted sera harbouring mutants with single or multiple amino acid (aa) substitutions, n = 40) and isolated anti-HBc positive samples were tested for the evaluation of sensitivity. Sera from HBsAg negative blood donors, pregnant women, hospitalized patients and potentially cross-reactive samples were investigated to determine the specificity of the new assay. The VIDAS HBsAg Ultra (L+S) had a higher sensitivity than the alternative assay for the detection of acute hepatitis B in seroconversion panels. The mean time of the diagnostic window was shortened with the VIDAS HBsAg Ultra (L) and (S) in comparison with the AxSYM HBsAg v2 by 1.06 and 0.66 days, respectively. The VIDAS HBsAg Ultra (L) did not detect one diluted sample out of six bearing the single aa G145R substitution, and two out of 12 diluted samples harbouring multiple aa substitutions. The analytical sensitivity of the assays varied from one surface mutant to another. While no false positive results were obtained with the VIDAS HBsAg Ultra (L+S) among potentially interfering samples, four false positives were detected with the AxSYM HBsAg v2. The respective values for sensitivity for the VIDAS HBsAg Ultra (L), (S) and the AxSYM HBsAg v2 were 99.07%, 97.87% and 94.14%. The specificities were 100% (VIDAS HBsAg Ultra L and S) and 99.6% (AxSYM HBsAg v2). In conclusion, the VIDAS HBsAg Ultra is highly sensitive and specific and represents an improvement for the detection of HBsAg in routine diagnostic laboratories.

PMID: 16567005 [PubMed - in process]

[Eos of the Eons]

I was denied once for testing low on blood iron. They gave me a pamphlet on how to raise my blood iron levels.

Suggestions include:

-Eat or drink something rich in vitamin C when eating the iron source. This means orange juice with steak, or a snack of raisins and almonds/nuts. I love spinach salad.

-Avoid caffeine around meals or the iron rich snacks. Caffeine interferes with iron absorption. I remember to not drink coffee for an hour before or after meals.

I've been able to donate every time after following their suggestions.

[Amraann]

I would not be begging for them to take my blood.
If they denied you then your off the hook. You did mention that your wife "guilted" you into it?

I personally take issue with my donating anything that makes someone else a ton of money. My blood may help someone but that someone is going to be paying a hell of a lot for getting it. ( to a hospital or DR for giving it) In most cases the DR isn't "donating" his or her time.
My hair to Locks of Love! OMG look up their history! Not even in good standing with the BBB. They have yet to explain why they recieve SOOOO much hair and donate sooo few wigs to little cancer patience..
Also Many donate and don't realize that LOL (locks of Love) doesn't take gray nor chemically treated hair.

[skeptigirl]

I would not be begging for them to take my blood.
If they denied you then your off the hook. You did mention that your wife "guilted" you into it?

I personally take issue with my donating anything that makes someone else a ton of money. My blood may help someone but that someone is going to be paying a hell of a lot for getting it. ( to a hospital or DR for giving it) In most cases the DR isn't "donating" his or her time.
My hair to Locks of Love! OMG look up their history! Not even in good standing with the BBB. They have yet to explain why they recieve SOOOO much hair and donate sooo few wigs to little cancer patience..
Also Many donate and don't realize that LOL (locks of Love) doesn't take gray nor chemically treated hair.
To my knowledge no one makes a profit off donated blood unless you consider the profit to labs for testing it.

This publication was prepared by America's Blood Centers and Pall Corporation. (http://www.americasblood.org/index.cfm?fuseaction=display.showPage&pageID=247)If nearly all blood comes from volunteers, why is there a charge?

While blood is donated at no cost by volunteers, blood centers charge a fee to cover the costs of recruiting blood donors and collecting, testing and distributing blood to hospitals. These "service fees" also apply when you're donating blood for your own use.

Hospitals also charge a fee for laboratory work, which makes sure the donated blood matches your blood type and for the transfusion procedure itself.

BTW, the reason you don't get paid for blood donations is to protect the blood supply from people who would otherwise lie about risk factors to get money for donating. You can get paid for donating at centers that use the blood for blood products and treat it for viruses before using it.

[Hydrogen Cyanide]

...My hair to Locks of Love! OMG look up their history! Not even in good standing with the BBB. They have yet to explain why they recieve SOOOO much hair and donate sooo few wigs to little cancer patience..
Also Many donate and don't realize that LOL (locks of Love) doesn't take gray nor chemically treated hair.

Perhaps it is good that the last time I gave my hair to "Wigs for Kids". I tried Locks of Love, but was annoyed that the hair salon charged me for shipping and gave me a crummy haircut! So I cut my hair myself last time!

Oops... off topic. sorry

Back on topic... this was an interesting series of programs about blood, blood products and giving blood (and yes, I do plan to give my A+ blood to the Puget Sound Blood Bank somewhere between chauffering kids to summer classes!):
http://www.pbs.org/wnet/redgold/

[skeptigirl]

We sent my son's hair to Locks of Love. The barber suggested it but didn't send it for us. I hadn't heard of Wigs for Kids.

The web site was clear about non-chem treated and who would think a kid with cancer would want a gray hair wig?

If we have another opportunity, I'll look into the W for K site.

[davefoc]

I have had a thought about where I might have gotten some kind of infection that perhaps was responsible for Hepatitis B.

I do quite a bit of plumbing work on an old apartment building and that occasionaly involves contact with various undesirable fludis. Any possibility that something like that might have led to a false positive or even a real possitive?

[wilks]

I have had a thought about where I might have gotten some kind of infection that perhaps was responsible for Hepatitis B.

I do quite a bit of plumbing work on an old apartment building and that occasionaly involves contact with various undesirable fludis. Any possibility that something like that might have led to a false positive or even a real possitive?

If you were coming in to contact with blood or body fluids then it is a possibility via wounds or broken skin.

[Deetee]

I have had a thought about where I might have gotten some kind of infection that perhaps was responsible for Hepatitis B.

I do quite a bit of plumbing work on an old apartment building and that occasionaly involves contact with various undesirable fludis. Any possibility that something like that might have led to a false positive or even a real possitive?

Dave, the lab tests you have had done for hepatitis B look for 2 things - small bits of the actual virus coat (surface antigen) and for any evidence you have previously been infected with the virus and that you have started to produce antibodies to it (antibodies to the core of the virus).

Your first screening test for surface antigen is positive, which might be taken to indicate that you have bits of the virus present in your blood (either you are a carrier, or you are newly infected). However, the second test to confirm this laboratory finding of antigen is negative, casting doubt on the positive finding of the first. Also, if you were a carrier of Hep B or had been infected with it in the past (more than a month or two ago) then you would contain antibodies in your blood - this you do not have, so this is ruled out.

Only 2 posibilities remain - the test is wrong (a false positive), or you have been very recently infected (in the last couple of weeks) and have not yet produced enough antibodies in your blood to show up on the antibody test.

Either way, a retest through your own doc is called for to clarify the matter. Until then, if you wish to play very safe, assume your blood and bodily fluids might be infectious to your wife/family and take necessary precautions.

I presume the Red cross are also playing it safe and that by their rules, once someone has tested positive they automatically reject them as a donor, even if it is proved that they are subsequently wrong about the test. All tests have a "failure rate" and the more you do, the likelier it is that uninfected people will turn up occasionally as "falsely positive".

Your final point about plumbing and bodily fluids - the main risk is through blood from an infected person getting into your own body somehow or into your mouth/eyes. Any blood in the piping system is likely to be quite diluted and less infectious, but it is still theoretically possible to get infected, I suppose. Do you recall any recent splashes into your face, or have you had cuts on your bare hands/arms? (I don't want to make you paranoid, I guess most plumbers have these more or less all the time, but you might recall a particular event)...Any contact with fluid that was visibly pink/reddish to indicate blood? These are theoretical ways of becoming infected (ie trully positive) and not causes of being false positive (false positivity just being a lab issue)

[StewartP]

I was born in Zimbabwe, lived 13 years in the UK and now live in France.

In Zimbabwe I gave blood often. No Problem.

When I moved to the UK I tried to give blood, but because of fears of AIDS/Malaria/Bilharzia they wouldn't touch me until I had been 18 months in the country. (Come back in 18 months and if you're still alive we'll consider screening you)
I gave blood regularly then in the UK for about 11 years.
Now I live in France, so wanting to be a good citizen I go off to give blood.
I was told they can't take my blood because I lived in the UK between the dates of mm/dd/yy and mm/dd/yy durng which time UK blood was not screened for vCJD and therefore I could have recieved contaminated blood, and with the prions long incubation period blah blah blah.

the irony is that back in the 80's French blood transfusion service failed to stop HIV infected blood from being given to haemophiliacs. Result, many people infected, many people diead and a Health Minister jailed (Result!)

It seems such a waste. I'm mr clean living, monogamous, straight and don't do drugs. I'm so middle of the road boring and clean it's scary. But the precautionary principle rules.

[Deetee]

Masakati, shamwari....

I too was born in Zim and left at age 26 in the mid 1980s
When I came to the UK, I found the blood banks had some rather strange wording for their donor exclusions.
After my time for "malaria" exclusion was complete and I could in theory become a donor, I found that I would be able to even though I was "Zimbabwean" (and therefore at risk you would think for HIV).

The exclusion wording went something like "If you have been a resident in and (my emphasis) have had sexual relations with someone who has been a resident in a country which is endemic for HIV infection..."
My girlfriend at the time was a girl who I had met while she was out visiting Zim, and we both came over to the UK. By the letter of the exclusion, she would not be able to give blood since she had had sex with myself (a Zim resident). Yet I could give blood, since I had only had sex with her (a UK resident). Go figure.

[skeptigirl]

Did they define resident, Deetee?

[valis]

I lived in the UK for 24 years, so they don't want my blood either.

Same here; I was stationed there in the early 80's. If I do get CJD I am going to sue Wimpy Burger for everything they have.

[StewartP]

And now an article on the BBC website indicates that by studying New Guinea cannibals it's possible that vCJD could have an incubation period of up to 50 years!

I'm 44 now. I might die of vCJD when I'm 94. Like I'm worried.

[sickstan]

I have been an occasional blood donor for many years. Principally because my wife guilts me into it.

The Redcross has been rejecting her blood for a long time because it falls just below the iron level they require. So my wife has pushed me to donate to compensate and after six months or so the guilt finally builds up to the level where I give blood.

So after my last trip I was surprised to get a letter from them telling me they don't want my blood either. Apparently they have a test for hepatitis B that came up positive.

According to the letter it is very unlikely that I have hepatitis B because several other tests came back negative, but out of an abbundance of caution and to comply with the federal government guidelines they have informed me that they don't want my blood anymore.

My test results:
Hepatitis B Surface Antigen (HBsAg. EIA) - POS

HBsAG Confirmatory Test (neutralization) - NEG


This test should probably be considered a negative -- EIA is more sensitive than specific and the confirmatory test (though I haven't heard of neutralization, I presume it's a dilution titer) is probably a more specific test. A true positive would indicate the chronic persistent form of the disease (a relatively rare outcome outside of infancy).

As far as additional tests for Hep B:

Hepatitis B surface antibody -- positive indicates immunity to Hepatitis B virus infection, acquired either through infection or immunization with the purified antigen derivative. A person with a positive test cannot possibly have the chronic persistent form of the disease.


Antibodies to Hepatitis B Core Antigen - NEG
(anti-HBc, IgG and IgM)


Hepatitis B core antibody -- positive indicates previous exposure to the actual virus (as opposed to the vaccine)


Antibodies to Hepatitis C Virus - NEG
(anti-HCV, EIA)
Anyway, I thought here and see if anybody has any comments.

I and a colleague both tested positive for the core antibody at our hospital's blood bank, but neither of us have previous history of infection or exposure. My colleague pursued the tests further and found that her test was false positive because of a "sticky serum syndrome". Regardless, I continue to test positive for Hepatitis B surface antibody and am therefore immune. I just may have problems having my donated blood accepted by a blood bank.

My comment to you is that the test is a false positive and that the blood bank is erring far to the precaution side to avoid even the whiff of risk. *shrug* your call as to whether or not you'd want to try donating again.

[skeptigirl]

....
Hepatitis B surface antibody -- positive indicates immunity to Hepatitis B virus infection, acquired either through infection or immunization with the purified antigen derivative. A person with a positive test cannot possibly have the chronic persistent form of the disease.This is incorrect. A person chronically infected may or may not have HBsAB. It occurs during the initial infection. And not all carriers are screened for surface antibody so the prevalence of HBsAB among carriers may not be known.


....your call as to whether or not you'd want to try donating again.I think he was correct to follow the blood bank's rules here. They are the experts and know why they are declining further donations. I don't want a transfusion from someone who decides to make the rules up for themselves, would you?

[skeptigirl]

After looking into the "sticky serum" syndrome you mention, it appears merely to be a name for non-specific antibody binding. That isn't necessarily a "syndrome" unless you have false positive tests for antibodies on multiple tests. If that were the case, then why trust the surface antibody test?

I find hep B core antibody occasionally on patients. The most common are foreign born. Hawaiian and Alaskan Native Americans have some risk. Dialysis patients have some risk. The next most common are IV drug users past or present. Then there are a few health care workers. Before the vaccine, there were ~12,000 health care workers infected with hepatitis B per year in the USA alone. There are also a few people who were infected through sexual intercourse. I have not seen reports of cases but I have seen blood exposures on construction sites and the barber shop. Finally, there are rare cases of people being infected via medical errors and some medical procedures.

Hep B infection only results in acute illness < 5% of the time.

The bottom line, you could have been infected and not have recognized the event.

[Deetee]

Did they define resident, Deetee?I can't recall exactly how it was defined, but remember us both reading the wording and concluding that although I was eligible to give blood, she could not just through the virtue (if that is the word!) of being my g/f.

[Deetee]

The current UK guidelines are here (http://www.transfusionguidelines.org.uk/docs/pdfs/uk_btg_edition_7_full.pdf) if anyone is interested. Chapter 10 gives info on the types of tests they perform for infections like hepatitis. Section 10.5 tells us how they re-instate donors who have been positive for any of the tests.

[rjh01]

The above link is a PDF document that is 358 pages long.

[Deetee]

The above link is a PDF document that is 358 pages long.Yes - perhaps I should have warned you all. It consists of the "Red Book" - the BTS bible on transfusion matters.
It is however relevant to look at chapter 10 as this section covers many of the queries raised in the above posts.

[chulbert]

BTW, the reason you don't get paid for blood donations is to protect the blood supply from people who would otherwise lie about risk factors to get money for donating. You can get paid for donating at centers that use the blood for blood products and treat it for viruses before using it. A close friend of mine is a risk manager for the ARC and said the reason they don't pay for blood is because it reduces the number of donations. It's no longer an act of charity when you pay the people and thus they donate less. Apparently those "warm fuzzies" are worth something.

This isn't to say you're wrong; perhaps they're both true. Donations decrease overall and the donations you do get are undesirable.

[skeptigirl]

A close friend of mine is a risk manager for the ARC and said the reason they don't pay for blood is because it reduces the number of donations. It's no longer an act of charity when you pay the people and thus they donate less. Apparently those "warm fuzzies" are worth something.

This isn't to say you're wrong; perhaps they're both true. Donations decrease overall and the donations you do get are undesirable.I don't care what your friend said, I've been in a closely related field of medicine for >15 years and it is to prevent people from lying about risk when they donate. Your friend knows not of what he/she speaks and both are not true as far as reasons for the rule.

You can get paid at any plasma collection site for your blood. You could just as easily have paid and donation sites for blood donors but we don't.


ARC? (http://www.google.com/search?q=ARC&start=0&ie=utf-8&oe=utf-8&client=firefox-a&rls=org.mozilla:en-US:official)

[sickstan]

This is incorrect. A person chronically infected may or may not have HBsAB. It occurs during the initial infection. And not all carriers are screened for surface antibody so the prevalence of HBsAB among carriers may not be known.

You'll need to source this. According to Harrison's Principles of Internal Medicine, Hepatitis B surface Antibody is indicative of resolution of disease or immunity from vaccination.

Edit: I'll save you the trouble. There are several sources some as old as 1983 but some more recent that progressively make the case for escape variants for HepBsAb to the standard strain. Rare, but prevalent. This calls into question the information available in textbooks and protocols for post-exposure prophylaxis and occupational prevention. Given the prevalence of chronic persistent hepatitis B in this country (US), I wonder if it would make any measurable difference in outcomes if concommittant testing for sAg and sAb were standard.

[davefoc]

....
Hepatitis B surface antibody -- positive indicates immunity to Hepatitis B virus infection, acquired either through infection or immunization with the purified antigen derivative. A person with a positive test cannot possibly have the chronic persistent form of the disease.

Dave's understanding:
The existence of the Hepatitis B surface antibody in an individual eliminates the possibility that Hepatitis B can survive in that individual indefinitely.

This is incorrect. A person chronically infected may or may not have HBsAB. It occurs during the initial infection. And not all carriers are screened for surface antibody so the prevalence of HBsAB among carriers may not be known.

Dave's understanding:
Even if an individual has the Hepatitis B surface antibody present, Hepatitis B may survive in that individual.

You'll need to source this. According to Harrison's Principles of Internal Medicine, Hepatitis B surface Antibody is indicative of resolution of disease or immunity from vaccination.

Edit: I'll save you the trouble. There are several sources some as old as 1983 but some more recent that progressively make the case for escape variants for HepBsAb to the standard strain. Rare, but prevalent.

Dave's understanding:
There are variations to Hepatitis B antibody that might not eliminate all forms of Hepatitis B infections.

This calls into question the information available in textbooks and protocols for post-exposure prophylaxis and occupational prevention. Given the prevalence of chronic persistent hepatitis B in this country (US), I wonder if it would make any measurable difference in outcomes if concommittant testing for sAg and sAb were standard.

Dave's understanding:
?


My apologies, but I am trying to follow this, but I don't quite understand what is being said. I posted what I understood below the quoted paragraphs.

[davefoc]

...

Your final point about plumbing and bodily fluids - the main risk is through blood from an infected person getting into your own body somehow or into your mouth/eyes. Any blood in the piping system is likely to be quite diluted and less infectious, but it is still theoretically possible to get infected, I suppose. Do you recall any recent splashes into your face, or have you had cuts on your bare hands/arms? (I don't want to make you paranoid, I guess most plumbers have these more or less all the time, but you might recall a particular event)...Any contact with fluid that was visibly pink/reddish to indicate blood? These are theoretical ways of becoming infected (ie trully positive) and not causes of being false positive (false positivity just being a lab issue)

I don't have any specific examples in mind. I would say that in almost every plumbing activity I am exposed to some splasing on the face and some skin contact. I probably average about 25 plumbing jobs a year and of those probably about 20 have to do with the drain system meaning unclogging, toilet removal and replacement and/or drain pipe replacement. I suspect my exposure is about one twentieth that of a professional plumber. I wonder if plumbers have higher rates of infection for any particular diseases.

I do remember working on a drain several years ago with my manager. We had tried to clear the drain with water pressure and I was working under the sink and when I removed the hose I got blasted with sewage from the pipe in the face. What had happened was that the water had traveled up the vent pipe instead of down the drain and just came blasting out when the hose was removed. Within about two days of that event I came down with a case of stomach flu that lasted for a few days.

[chulbert]

I don't care what your friend said, I've been in a closely related field of medicine for >15 years and it is to prevent people from lying about risk when they donate. Your friend knows not of what he/she speaks and both are not true as far as reasons for the rule.

You can get paid at any plasma collection site for your blood. You could just as easily have paid and donation sites for blood donors but we don't.


ARC? (http://www.google.com/search?q=ARC&start=0&ie=utf-8&oe=utf-8&client=firefox-a&rls=org.mozilla:en-US:official) Surely someone with 15+ years in a "closely related field" should have run across the abbreviation for American Red Cross.

Anyways, clearly a risk manager in the blood services division of the American Red Cross knows less about their own policies than you do so I'll concede defeat and bow out of the discussion. Have a nice day.

[skeptigirl]

You'll need to source this. According to Harrison's Principles of Internal Medicine, Hepatitis B surface Antibody is indicative of resolution of disease or immunity from vaccination.

Edit: I'll save you the trouble. There are several sources some as old as 1983 but some more recent that progressively make the case for escape variants for HepBsAb to the standard strain. Rare, but prevalent. This calls into question the information available in textbooks and protocols for post-exposure prophylaxis and occupational prevention. Given the prevalence of chronic persistent hepatitis B in this country (US), I wonder if it would make any measurable difference in outcomes if concommittant testing for sAg and sAb were standard.
Post exposure prophylaxis for hep B has overwhelming evidence of being effective. Unlike HIV and Hep C antibodies which are not protective, hepatitis B surface antibody is protective. The vaccine failure rate is not equal to the carrier rate in persons infected so failure to produce surface antibody is not the only factor involved in disease.

Vaccine induced surface antibody is protective. During acute infection with hepatitis B some surface antibody can be detected even when chronic infection is the outcome. For whatever reason, sAB is too little and/or too late for those that go on to acquire chronic disease (carrier state). Giving HBIG (someone else's surface antibody) after exposure to hep B is almost 100% effective if given within 24 hours of exposure then the effectiveness drops off until only disease modification can be expected (after 7 days) and after 14 days no effect is likely.

In long term studies of people successfully vaccinated for hepatitis B, a few have developed core antibody but none have developed disease, either acute or chronic. Infection occurred in these people. This is the basis CDC sites for ongoing recommendation that no boosters are needed for people successfully vaccinated.

Another interesting fact is that people who go on to be chronically infected rarely if ever have acute symptoms. So a person with acute symptomatic hepatitis B is likely to die or recover. The person who becomes a carrier is likely to have never had symptoms with the initial infection. This correlates with the larger percentage of carriers which occurs in the infants infected. The immune response gives one symptoms of acute liver disease. No immune response and one has a greater chance of becoming a carrier. Yet 85% or so of adults infected have no symptoms and do not become carriers.

The bottom line here is the immune system and infectious viruses have very complex interactions we just don't know all the details of yet.

As for the variant Hep B, don't worry about that too much yet. It is extremely rare and has not yet added to the hep B disease burden in the USA. If you aren't in the US you may need to check local prevalence but I haven't heard it is common anywhere.

As for medical textbooks, all textbooks are out of date by the time they are published. That's the nature of how fast we are acquiring new information. In addition, general sources like Harrison's and the Merck Manual are extremely useful but aren't going to be comprehensive with all sorts of finer details one might find if one was using a resource geared toward a medical specialty.

You can rely on the PEP guidelines published by CDC. They are based on the best information available and are updated regularly. I also read the MMWR every week to keep up on anything more current than the published guidelines.

[skeptigirl]

Surely someone with 15+ years in a "closely related field" should have run across the abbreviation for American Red Cross.

Anyways, clearly a risk manager in the blood services division of the American Red Cross knows less about their own policies than you do so I'll concede defeat and bow out of the discussion. Have a nice day.To me ARC means AIDS related complex. It's an outdated term no longer used.

You would be amazed at how many abbreviations are used in various fields that anyone outside the field wouldn't automatically know. We have the Puget Sound Blood Center here and the Red Cross is not the responsible party.

FYI, I am a nurse practitioner. I have a specialty practice which I started 16 (I recounted) years ago. I contract with 100s of employers to manage occupational exposures to infectious disease. I also teach employees about infectious disease hazards, write related policies, act as consultant in all areas of occupational infectious disease hazards and act as the infection control consultant at a local psych hospital. My clients are police, fire, dentists, nursing homes, parks/recreation and public works employers, security firms, an organ donor group and a couple doctor's offices as well.

As far as related to blood donations, I see people every week that have had blood exposures and I give more than 1,000 doses of hep B vaccine per year. I work with the blood bank occasionally to get donor information if they are the source of an exposure. It is one of the few reasons the blood bank will release any information on lab results except those letters to the donor when the results need to be disclosed.

[skeptigirl]

I don't have any specific examples in mind. I would say that in almost every plumbing activity I am exposed to some splasing on the face and some skin contact. I probably average about 25 plumbing jobs a year and of those probably about 20 have to do with the drain system meaning unclogging, toilet removal and replacement and/or drain pipe replacement. I suspect my exposure is about one twentieth that of a professional plumber. I wonder if plumbers have higher rates of infection for any particular diseases.

I do remember working on a drain several years ago with my manager. We had tried to clear the drain with water pressure and I was working under the sink and when I removed the hose I got blasted with sewage from the pipe in the face. What had happened was that the water had traveled up the vent pipe instead of down the drain and just came blasting out when the hose was removed. Within about two days of that event I came down with a case of stomach flu that lasted for a few days.
I have a few public works departments as clients. The CDC does not include sewer work in the occupational risk category for bloodborne pathogens unless they are working on pipes which are directly outflowing from a hospital or similar facility. The reason is there is not a greater rate of hepatitis B among sewer workers than among people not employed in that field. There is also not a greater rate of hepatitis A among sewer workers.

However, I have managed occupational exposures in public works employees and a couple of the cities here do include those workers in their exposure plans. And one city gives the pub. works employees hepatitis A vaccine because the union requested it. If employees are involved in street sweeping and drain unclogging, there have been hypodermic syringes found in those locations. I also had a guy get a "face full" when a pipe he was under came apart and there was a condom visible in the material.

What I advise employers is if there have been any potential exposures, like finding syringes, then employees should be considered at risk. Providing hepatitis B vaccine goes a long way toward employee satisfaction as well.

What I explain to the workers is the sewer is full of infectious organisms. Hepatitis is not the organism to be worried about. Viruses do not multiply outside of a cell like bacteria do. The risk in sewage is only present if there is frequent blood in those particular pipes. Sometimes that is the case. So risk varies.

You don't take prophylactic antibiotics everyday just because you could get splashed so there is an argument hep B vaccine isn't always indicated. If sewer workers were getting hep A or B then that would be different. OTOH, I do expect these guys to wear a face shield and I rarely see them use one. I'd rather see an employer provide and require face shields than give a vaccine for a virus that isn't very likely to be in the sewage that splashed in their face that day.

[skeptigirl]

Detecting Hepatitis B Surface Antigen Mutants (http://www.cdc.gov/ncidod/EID/vol12no02/05-0038.htm) is a CDC article with some general information on B variants.

[thatguywhojuggles]

Growing up as a child in Bolivia I had both hepatitus and typhoid. I haven't even bothered to try to give blood.

[skeptigirl]

Growing up as a child in Bolivia I had both hepatitus and typhoid. I haven't even bothered to try to give blood.Any history of hepatitis excludes blood donation at this time. While there wouldn't be an issue if it was provable you only had hep A, there is still a transmissible blood borne hepatitis which is seen but hasn't been identified. For a while it was thought to have been found and given the name hepatitis G (we don't know what happened to F, there is a D and E hepatitis). But the virus identified does not seem to be the culprit.

Hep G (http://www.phac-aspc.gc.ca/hcai-iamss/bbp-pts/hepatitis/hep_g_e.html)
More Hep G (http://www.cumc.columbia.edu/dept/gi/hepG.html)

Looks like there's a lot more info since I last checked. Guess I best go read some.

[Stitch]

-Eat or drink something rich in vitamin C when eating the iron source.

Guniess and OJ? :D