Unusual hepatitis B virus findings in blood donors

Christopher D Swan, Clive R Seed, Claire E Styles and Iain B Gosbell
Med J Aust 2023; 219 (2): . || doi: 10.5694/mja2.52001
Published online: 17 July 2023

A 66‐year‐old, hepatitis B virus (HBV) unvaccinated male blood donor exhibited repeatedly reactive multiplex nucleic acid test (NAT) results for human immunodeficiency virus type 1, hepatitis C virus and HBV, and non‐reactive discriminatory HBV NAT and hepatitis B surface antigen (HBsAg) results. Twenty‐eight previous donations since 2010 were HBV NAT non‐reactive. Total hepatitis B core antibody (anti‐HBc) results were repeatedly reactive and HBsAg antibody (anti‐HBs) results were also reactive, while e‐antigen (HBeAg), HBeAg antibodies (anti‐HBe) and anti‐HBc IgM were non‐reactive. National Reference Laboratory (NRL) HBV NAT results were reactive. These results were consistent with occult HBV infection (OBI). The donor, his parents, and his partner were born in Taiwan.

  • 1 Nepean Blue Mountains Local Health District, Sydney, NSW
  • 2 Australian Red Cross Blood Lifeblood, Perth, WA
  • 3 Australian Red Cross Blood Lifeblood, Sydney, NSW
  • 4 Western Sydney University, Sydney, NSW

Patient consent

The patients gave written consent for publication.


Australian governments fund Australian Red Cross Lifeblood to provide blood, blood products and services to the Australian community.

Competing interests:

No relevant disclosures.

  • 1. Australian Red Cross Lifeblood. Australian Red Cross Lifeblood Annual Report 2021–2022.‐strategy/annual‐reports (viewed May 2023).
  • 2. Kiely P, Margaritis AR, Seed CR, et al. Hepatitis B virus nucleic acid amplification testing of Australian blood donors highlights the complexity of confirming occult hepatitis B virus infection. Transfusion 2014; 54: 2084‐2091.
  • 3. Seed CR, Allain JP, Lozano M, et al. International forum on occult hepatitis B infection and transfusion safety. Vox Sang 2019; 114: e1‐e35.
  • 4. Deng X, Guo X, Gu H, et al. Anti‐HBc‐nonreactive occult hepatitis B infections with HBV genotypes B and C in vaccinated immunocompetent adults. J Viral Hepat 2022; 29: 958‐967.
  • 5. Raimondo G, Locarnini S, Pollicino T, et al. Update of the statements on biology and clinical impact of occult hepatitis B virus infection. J Hepatol 2019; 71: 397‐408.
  • 6. Seed CR, Kiely P, Hoad VC, et al. Refining the risk estimate for transfusion‐transmission of occult hepatitis B virus. Vox Sang 2017; 112: 3‐8.
  • 7. Australian Red Cross Lifeblood. Risk estimates for transfusion‐transmissible infections (TTI).‐professionals/clinical‐practice/adverse‐events/other‐transfusion‐transmitted‐infections/transfusion‐transmissible‐infections (viewed May 2023).
  • 8. O'Flaherty N, Ushiro‐Lumb I, Pomeroy L, et al. Transfusion‐transmitted hepatitis B virus (HBV) infection from an individual‐donation nucleic acid (ID‐NAT) non‐reactive donor. Vox Sang 2018; 113: 300‐303.


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