One of the criteria for blood donation is that a prospective donor should not have had infectious hepatitis after the age of 12. In addition it must have been a year since the prospective donor had close contact with someone who has infectious hepatitis It is easy to get confused about who should donate and who should not because the term hepatitis is usually associated with a viral infection.
The word “hepatitis” comes from the Greek word for the liver, “hepat” plus the Greek suffix for inflammation, “-itis”. So, hepatitis simply means inflammation of the liver. Liver inflammation can have many causes - chemicals (drugs), autoimmune diseases, and surgical conditions to name a few. Viruses, however, target the liver cells. They are designed to attack the liver cells in order to make new viruses. When there are too many viruses in the cell, it bursts releasing millions of new viruses to infect other liver cells. This process results in the liver inflammation, hepatitis. The reason why we defer donors with infectious hepatitis or exposure to infectious hepatitis is because, unlike other causes, the viruses can be transmitted through the blood.
Chemicals associated with hepatitis include alcohol, carbon tetrachloride, vinyl chloride, the herbicide paraquat and polychlorinated biphenyls. Over the counter pain relievers such as aspirin, ibuprophen (Advil, Motrin), naproxen (Aleve) and acetaminophen (Tylenol) can cause liver inflammation, especially when combined with alcohol. Prescription medications such as halothane (a general anesthetic), isoniazide (antibiotic for TB), valproic acid (Depecote), phenytoin (Dilantin) most cholesterol lowering agents and other drugs can cause hepatitis. Some herbal medicines also can cause liver inflammation including cascara, chaparral, comfrey, kava, and ephedra. Hereditary metabolic disorders, such as Wilson’s disease, hemochromatosis or non-alcoholic fatty liver disease, cause liver inflammation because of abnormal accumulation of material (copper, iron or fat) in the liver cells causing them to rupture. Autoimmune disease can attack the liver cells, or ducts of the liver causing inflammation. Stones in the gallbladder can cause bile to back up into the liver causing hepatitis. None of these causes of hepatitis are due to a viral infection, and once the donor is recovered, evaluation for blood donation should be permitted, as long as the donor is otherwise in good health.
A number of viruses have been associated with hepatitis. Hepatitis A is usually acquired from ingesting contaminated food. Hepatitis B is transmitted through contact with contaminated blood or body fluid, as is Hepatitis C. Much rarer are Hepatitis viruses E, D and G (I don’t know where hepatitis F went). Usually when a person gets hepatitis A or B they develop flu-like symptoms. Less often, the person becomes very sick needs to be hospitalized. However, most often when the person recovers the virus is gone and no longer infectious. Today, even hepatitis C responds pretty well to treatment and the virus becomes undetectable. So, even though a donor can be exposed to someone who had hepatitis, because the exposure was not to someone who has hepatitis it is ok to evaluate the donor for blood donation at the time they present to donate.
Hepatitis viruses can be a little tricky. They can cause a low level infection, “chronic hepatitis.” People with chronic hepatitis have hepatitis. These individuals cannot donate. A prospective donor who has been exposed to a person with chronic hepatitis or active hepatitis can become infected by the virus and transmit hepatitis through the blood. It is permissible to evaluate these donors one year after the most recent exposure to someone who has hepatitis, either acute or chronic.
In summery:
1. Hepatitis is not always caused by a virus.
2. A person may donate without deferral if the person is in good health and had hepatitis due to a non-infectious cause.
3.A person may donate without deferral if exposed to a person who had viral hepatitis more that a year ago, but no longer has hepatitis.
4. A person who has ever had viral hepatitis after age 12 may not donate.
5. A person who has viral chronic hepatitis still has hepatitis.
6. A donor who was exposed to a person with virus caused hepatitis or chronic hepatitis may be evaluated to donate one year after the most recent exposure.
D. Kip Kuttner, D.O. holds a BA in Molecular, Cellular and Developmental Biology from the University of Colorado, and his D.O. from the College of Osteopathic Medicine of the Pacific. Dr. Kuttner completed his internship at the Tulsa Regional Medical Center, his residency at the Harbor-UCLA Medical Center, and Fellowships at Harbor-UCLA Medical Center, Long Beach Memorial Medical Center, and the American Red Cross Blood and Tissue Services. He is certified by the National Board of Osteopathic Medical Examiners and the American Board of Pathology in Anatomic and Clinical Pathology, as well as Transfusion Medicine and Blood Banking. He has served as Miller-Keystone Blood Vice President/Medical Director since 1995.
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