Blood Banks Pass Up Test That Might Have Prevented Thousands of Infections

U.S. blood banks in the early 1980s failed to use a screening test for hepatitis C that could have prevented thousands of infections, the Kansas City Star reported. The Star used data from studies at the time and estimated that if screening that detected an enzyme indicating liver damage had been implemented, more than 300,000 HCV infections might have been prevented.

A group of blood industry experts -- including representatives from the American Red Cross, the American Association of Blood Banks and the Council of Community Blood Centers -- met in Washington in 1981 and decided ALT [alanine aminotransferase serum] testing for HCV would decrease the number of patients infected by transfusion.

For the next five years, however, the industry left ALT testing on hold, citing a lack of scientific evidence that it would reduce HCV cases in practice. It also worried about the difficulty in setting up the testing -- a working group that was appointed at the January 1981 meeting to draft guidelines never met.

In addition, blood industry leaders argued that they would lose many donors. Of those who tested positive in the ALT test, they pointed out, only a third might have HCV. However, two extensive studies had estimated that only 1.5-3 percent of all donors would be excluded.

"In hindsight, maybe we could have done differently, but that's hindsight," said Paul Holland, who chaired the blood industry committee on hepatitis testing in 1981.

Just how many infections the ALT test could have prevented is impossible to estimate. And there is no way to determine how many people among the approximately 450,000 HCV patients infected by transfusion are alive today.

"Certainly if I had seen this information I would have had the test in place in 1981," said Ron Gilcher, head of the Oklahoma Blood Institute, who nonetheless broke ranks and began testing in 1983.

Johanna Pindyck, a participant at the 1981 meeting, also began using the test at her blood bank. "This was a serious disease, and it was a preventable disease," said Pindyck, who was director of the Greater New York Blood program.

In 1986, the Red Cross and other blood associations asked blood banks to use the ALT and hepatitis B core antibody tests. By 1987, most did. In 1992, new tests screened almost all hepatitis C from the blood supply.

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