Tests Alanine Aminotransferase Research Articles

Evaluation of technical and behavioral issues in predonation alanine aminotransferase testing.

To evaluate the technical and behavioral impact of predonation alanine aminotransferase (ALT) testing, one group of 2914 donors (Reflotron group) were tested with the Boehringer Mannheim Reflotron instrument; 3042 control group donors had no predonation test. Mobile blood collection sites in three regional blood centers were studied. More Reflotron group donors than control group donors thought that predonation testing did not add time and was a good idea. Both groups were equally satisfied with the donation process and indicated they would donate again even if testing added time. Comparison of the Reflotron and standard laboratory tests showed excellent correlation with low variability. The mean r value was 0.934, with a mean sensitivity of 94.4 percent and a specificity of 99.8 percent. The staff working with the Reflotron group found predonation testing easy to incorporate into donor screening. They observed that donors were pleased with testing and accepting of deferral counseling for elevated ALT. The control group staff was concerned that predonation testing would require more time and would have a negative effect on the donor return rate. This did not appear to be the case as judged by donor response and the 6-month return rates of 50 percent for Reflotron group and 54 percent for control group donors.

Donor ALT Testing as Means to Reduce Posttransfusion Hepatitis

The policy of testing all blood donors for the presence of HBsAg has not succeeded in eliminating posttransfusion hepatitis. This is because the majority of cases are non-A, non- B (NANB) hepatitis; serologic tests for carriers of this disease are not available. The incidence of apparent NANB infection among blood recipients maybe as high as 10-12%. Recent studies suggest that blood donors with elevated alanine aminotransferase (ALT) levels are more often associated with this infection in recipients. Implementation of donor ALT testing would result in a number of problems including attrition of the blood resource, difficulties in test standardization and interpretation, development of a rationale for donordeferral and counseling, and significant additional costs for provision of blood. There is a lack of information about the extent and severity of clinically significant posttransfusion NANB hepatitis. A careful analysis of the advantages and disadvantages of ALT testing should be completed before any measures are taken to develop policies in this area.

Nationwide ALT testing to prevent non-A, non-B hepatitis still on hold

Testing A esting blood for elevated alanine aminotransferase (ALT) levels in an effort to prevent non-A, non-B (NANB) hepatitis is a procedure that is gaining support, but the consensus of those in blood banking is that nationwide testing is not warranted yet. One blood bank plans to go ahead with the testing, however. An ad hoc committee of the American Association of Blood Banks (AABB) deliberated the topic at the association's recent meeting in Chicago and decided against recommending routine testing. "Nearly everybody feels there is insufficient information for a national policy change right now, particularly one which has so many ramifications," said committee chairman Joseph Bove, MD, professor of laboratory medicine and director of the blood bank at Yale University Medical Center, New Haven, Conn, in an interview with<i>JAMA</i>MEDICAL NEWS. The questions that were in everyone's mind were summarized at a session on new techniques of hepatitis

Donor Transaminase and Recipient Hepatitis

To assess the relationship of donor alanine aminotransferase (ALT) level to recipient hepatitis, 283 transfused patients were prospectively followed up after open heart surgery; hepatitis developed in 12.7%, of which 97% was non-A, non-B. The ALT tests of 3,359 donors to these patients indicated that risk of hepatitis was significantly associated with the level of donor ALT; 29% of 52 patients receiving at least 1 unit of blood with an ALT level greater than 53 IU/L had hepatitis develop (20.7 cases per 1,000 units), compared with 9% of 231 recipients of only blood with an ALT level of 53 IU/L or less (7.8 cases per 1,000 units). Calculation of corrected efficacy predicts that, at an exclusion level equivalent to 2.25 SDs above the mean log for normal subjects, ALT testing of donors could prevent 29% of posttransfusion hepatitis at the loss of 1.6% of donor units.