Blood donation screening for hepatitis B virus core antibodies: The importance of confirmatory testing and initial implication for rare blood donor groups

Abstract Background and Objectives Exclusion of blood donors with hepatitis B virus (HBV) core antibodies (anti‐HBc) prevents transfusion‐transmitted HBV infection but can lead to significant donor loss. As isolated anti‐HBc positivity does not always indicate true past HBV infection, we have investigated the effectiveness of confirmatory anti‐HBc testing and the representation of rare blood groups in anti‐HBc‐positive donors. Materials and Methods Three hundred ninety‐seven HBV surface antigen‐negative and anti‐HBc initially reactive blood donor samples were tested by five different anti‐HBc assays. Results Eighty percentage of samples reactive in Architect anti‐HBc assay were positive by the Murex assay and anti‐HBc neutralization. Eleven out of 397 samples showed discordant results in supplementary testing from the Murex confirmatory test result, and five remained undetermined following extensive serological testing. Thirty‐eight percentage of anti‐HBc‐positive donors identified as minority ethnic groups compared with 11% representation in anti‐HBc‐negative donors ( p < 0.0001); the frequency of the Ro blood group in anti‐HBc‐positive donors was 18 times higher in non‐white ethnic groups. Conclusion Using two anti‐HBc assays effectively enabled the identification of HBV‐exposed and potentially infectious donors, their deferral and potential clinical follow‐up. However, the exclusion of confirmed anti‐HBc‐positive donors will still impact the supply of rare blood such as Ro.