Hepatitis C and transfusion: A 'lookback' primer
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
In 2000, primary care physicians, surgeons, and other medical specialists began receiving notification from hospital blood banks that a patient they had previously treated or were currently treating may have been exposed to hepatitis C virus (HCV) as a result of blood transfusion. This United States Public Health Service (USPHS)-mandated notification, developed in conjunction with the US Food and Drug Administration (FDA), may have come as a surprise to community physicians who were faced with the task of locating patients, informing them about the possible exposure, providing appropriate testing and counseling, and possibly evaluating or treating those who were found to be HCV positive, in a process referred to as "lookback."
Strictly speaking, lookback is the process through which patients who may have received pathogen-infected blood are identified by tracing a suspect donor's previous donations to those recipients for the purpose of testing, evaluation, and providing treatment as indicated. Transfusion recipients who are the focus of HCV lookback are those who have been transfused with blood from a now HCV-confirmed positive donor who either had not been previously tested for HCV or who was negative for HCV at the time of previous donations; or from a donor who is now HCV test reactive, but results cannot be confirmed, or further testing cannot performed using an assay that meets FDA specifications. Lookback is required for other pathogens such as HIV, but hepatitis C was unique because of the United States federal government's prescriptive requirements for patient notification that involve the physician of record.
Recognizing that involvement in an HCV lookback process is an infrequent and possibly new experience for many practitioners, the purpose of this discussion is to review the rationale for HCV lookback, define lookback, outline regulatory expectations, and provide physicians in the United States with resources that can make the patient notification process less onerous. Similar programs exist in other countries.
Recommendations for screening and diagnosis of HCV infection in the general population is presented separately. (See "Screening for chronic hepatitis C virus infection".)
GOVERNMENT RESPONSE TO THE HCV EPIDEMIC AND THE HISTORY OF HCV LOOKBACK
It is estimated that up to four million Americans are infected with HCV . The majority of these individuals have been exposed to the virus through the sharing of needles used in injection drug use, and a smaller percentage through sexual contact, perinatally, or occupationally. Approximately one-third of infected people do not identifiably fall into these risk categories, but have a history of behavior, such as multiple sex partners, that places them at higher risk [2,3]. (See "Epidemiology and transmission of hepatitis C virus infection".)
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