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Childhood cancer survivors who received blood or blood products before screening tests were available for hepatitis B and C may be at risk for developing hepatitis, an infection of the liver.

In the United States, routine screening of blood donors for the hepatitis B virus began in 1971. For hepatitis C, the most accurate screening began in 1992. Screening in other countries may be different.

Blood Products That May Cause Hepatitis

Survivors may be at risk for hepatitis B (if transfused before 1972) and C (if transfused before 1993) if they received any of the blood products listed before routine blood donor screening began:

  • Packed red blood cells
  • Whole blood
  • Granulocytes (white blood cells)
  • Platelets
  • Fresh frozen plasma
  • Cryoprecipitate
  • Immunoglobulin preparations (IVIG, VZIG)
  • Bone marrow or stem cells from another person (allogeneic donor)

Other Risk Factors for Hepatitis

  • Blood-clotting proteins produced made before 1987
  • Solid organ transplants such as kidney, liver, or heart before 1993
  • Long-term kidney dialysis
  • Shooting or snorting drugs
  • Body piercings or tattoos
  • Sharing of razors, toothbrushes, or nail clippers with people who have hepatitis
  • Exposure to blood and body fluids in the workplace
  • High-risk sexual behavior (multiple sex partners, failure to use protection and anal sex)

Signs and Symptoms of Hepatitis

Not all patients with hepatitis have symptoms when first infected. However, symptoms of hepatitis may include:

  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Fever
  • Jaundice
  • Dark urine
  • Severe itching
  • Pale stools

In rare cases, liver failure can result.

Sometimes hepatitis resolves without therapy and causes no further health problems.

People infected with hepatitis B or C as children may develop a chronic infection. Most people with chronic hepatitis do not have symptoms. But chronic infection can cause scarring (cirrhosis) of the liver and other liver problems. Signs of liver damage include:

  • Swelling of the liver and spleen
  • Swelling or collection of fluid in the abdomen
  • Jaundice
  • Problems with blood clotting
Hepatitis is an infection of the liver.

Hepatitis is an infection of the liver.

What Survivors Can Do

  1. Ask your health care provider about your transfusion history and risk of developing hepatitis.

    Share a copy of your Survivorship Care Plan, which includes details about your cancer treatment, including blood transfusions, and information about health problems that may occur because of your treatment.

    A blood test can check for viral hepatitis. A positive antibody test for hepatitis B or C means the person has been exposed to the virus. Additional testing may then be performed to check for chronic infection.

    • Survivors with chronic hepatitis B or C should visit a liver specialist for evaluation and treatment.
    • Tell the doctor about all over-the-counter medications and supplements you are taking.
    • Do not drink alcohol. It can cause further liver damage.
    • Avoid over-the-counter medications containing acetaminophen (such as Tylenol®).
    • If you have chronic hepatitis C, have a blood test to see if you have immunity to hepatitis A and B. If you do not have immunity, get immunized for hepatitis A and B to protect your liver. There is not a vaccine for hepatitis C.
    • Discuss your hepatitis with all of your health care providers. If you are pregnant, discuss this with both your obstetrician and the baby’s pediatrician.
  2. Additional steps to keep the liver healthy include:

    • Drink plenty of water.
    • Eat a well-balanced diet that is high in fiber.
    • Reduce intake of fatty, salty, smoked, and cured foods.
    • Take recommended doses of medications and avoiding unnecessary medications.
    • Do not mix drugs and alcohol.
    • Do not use illegal drugs.
    • Be careful about using herbs and natural supplements, especially combining them with medications.
    • Avoid exposure to solvents, aerosol cleaners, insecticides, paint thinners, and other toxins.
  3. Survivors with chronic hepatitis B or C should take precautions to avoid spreading the disease.

    • Avoid direct contact of blood and body fluids with others.
    • Use bleach to clean spilled blood or body fluids.
    • Cover cuts or other open sores.
    • Do not share personal care items that may come in contact with blood such as razors, toothbrushes, nail clippers, earrings, and rings on other parts of the body.
    • Use sterile needles for body piercings, injections, tattoos, and acupuncture. Never share needles.
    • Make sure close household members and sexual partners are screened for hepatitis B. If they do not have immunity, they should receive the hepatitis B vaccine.
    • If you are sexually active, use barrier protection such as latex condoms during sex.
    • Talk with your health care provider about whether your sexual partner should be tested for hepatitis C.

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Reviewed: December 2019