Elevated Alanine Aminotransferase in Blood Donors: Role of Different Factors and Multiple Viral Infections

Abstract

Many different aetiological agents stimulate alanine aminotransferase (ALT) production. Viral markers and other aetiologies were investigated in 2166 individuals, randomly selected from 10 000 consecutive blood donors. Elevation of ALT was found in 10.8% of subjects. Grouping donors according to ALT level and correlating with, respectively, hepatitis B core antibody (HBcAb), cytomegalovirus antibody alone, or associated with HBcAb, showed similar findings (high ALT 11.1%, normal 11.6%; high 85.4%, normal 81.4%; high 10.2%, normal 11.0%, respectively). Hepatitis C virus (HCV) antibody was found to be significantly associated with elevated ALT levels (high 1.7%, normal 0.26%). Other causes of ALT elevation were alcohol abuse (17%), obesity (25%) and dyslipidaemia (38%), but in 11% there was no obvious aetiology. Although HCV is a rare cause of elevated ALT in blood donors, it seems to be the only virus, among those tested, to account for liver damage. This may be due to the non-protective role of HCV antibody, the low specificity of ALT, or the pathogenic role of uninvestigated viruses.

Keywords

Alanine aminotransferase elevation Blood Donors HCV HBV Hepatitis Viruses

References

Friedman

Dienstag

Watkins

Evaluation of blood donors with elevated serum alanine aminotransferase levels. Ann Intern Med 1987; 107: 137–144.

Kuo

Choo

Alter

An assay for circulating antibodies to a major etiologic virus of non-A, non-B hepatitis. Science 1989; 244: 362–364.

Alter

Purcell

Shih

Detection of antibodies to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. N Engl J Med 1989; 321: 1429–1500.

Esteban

Gonzales

Hernandez

Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis. N Engl J Med 1990; 323: 1107–1112.

Sirchia

Almini

Bellobuono

Prevalence of hepatitis C virus and antibodies in Italian blood donors. Vox Sang 1990; 59: 26–29.

Glantz

(ed): Statistica per discipline biomediche, 2nd edn. Milan: McGraw Hill, 1988.

Hoefs

Wang

Kanel

The liver-spleen scan as a quantitative liver function test: correlation with liver severity at peritoneoscopy. Hepatology 1995; 4: 1113–1121.

Katkov

Friedman

Cody

Elevated serum alanine aminotransferase levels in blood donors: the contribution of hepatitis C virus. Ann Intern Med 1991; 115: 882–884.

Wejstal

Hansson

Lindholm

Persistent alanine aminotransferase elevation in healthy Swedish blood donors. Vox Sang 1988; 55: 152–156.

10.

Lai

Mazzoleni

Farci

Markers of hepatitis C virus infection in Sardinian blood donors: relationship with alanine aminotransferase levels. J Med Virol 1993; 41: 282–288.

11.

Tsuda

Liver disfunction caused by parvovirus B19. Am J Gastroenterol 1993; 88: 1463.

12.

Tassopoulos

Hatzakis

Kuhns

Clinical and laboratory features of acute community-acquired non-A, non-B, non-C hepatitis. In: Viral Hepatitis and Liver Disease ( Nishioka

Suzuki

Mishiro

Oda

eds). Tokyo: Springer-Verlag, 1994; pp80 – 84.

13.

Penna

Artini

Cavalli

Long lasting memory T cell responses following self-limited acute hepatitis B. J Clin Invest 1996; 98: 1185–1194.

14.

Rehermann

Lau

Hoofnagle

Cytotoxic T lymphocyte responsiveness after resolution of chronic hepatitis B virus infection. J Clin Invest 1996; 97: 1655–1665.

15.

Hultcrantz

Glaumann

Lindberg

Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases. Scand J Gastroenterol 1986; 21: 109–113.

16.

Lavorino

Mannella

Salvatori

Antibodies anti-Parvovirus B-19 in chronic hepatitis C virus infection. Am J Gastroenterol 1995; 90: 676–677.

17.

Kundrotas

Clement

Serum alanine aminotransferase (ALT) elevation in asymptomatic US Air Force basic trainee blood donors. Dig Dis Sci 1993; 38: 2145–2150.

18.

Bacon

Farahvash

Janney

Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 1994; 107: 1103–1109.