Treatment for childhood cancer often requires transfusions of blood and blood products. For many years, blood donors have been routinely screened for harmful viruses, such as hepatitis B and C. These viruses are spread through the blood. However, people who received blood and blood products before screening was in place may be at risk for developing hepatitis, an infection of the liver.
In the United States, routine screening of blood donors for hepatitis B began in 1971. For hepatitis C, the most accurate screening began in 1992. Screening in other countries may be different.
Hepatitis B and C can also be spread other ways, such as:
- Needle sharing among drug users
- Body piercing
- Kidney dialysis
- Organ transplant
- Sexual contact
- From mother to newborn during the birthing process
How the Liver Functions
The liver is a triangular-shaped organ located under the rib cage on the right side of the body. It helps clear wastes from the blood, makes bile to help digest food, produces blood-clotting proteins, and stores energy to fuel the body.
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
- White blood cells (granulocytes)
- Fresh frozen plasma
- Immunoglobulin preparations (IVIG, VZIG)
- Bone marrow or stem cells from another person (allogeneic donor)
Additional risk factors include:
- Blood-clotting proteins produced made before 1987
- Kidney, liver, or heart transplants before 1993
- Long-term kidney dialysis
- Shooting drugs or snorting drugs
- Body piercings or tattoos
- Sharing of razors, toothbrushes, or nail clippers with people infected with 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:
- Loss of appetite
- Dark urine
- Severe itching
- Pale stools
In rare cases, liver failure can result.
Sometimes hepatitis can resolve itself and cause no further health problems.
People infected with hepatitis B or C as children may become chronically infected. Most people with chronic hepatitis do not have symptoms. But it can cause scarring (cirrhosis) of the liver and other liver problems. Signs of progressive liver damage include:
- Enlargement of the liver and spleen
- Swelling or collection of fluid in the abdomen
- Yellow color of the eyes and skin (jaundice)
- Problems with blood clotting
What Survivors Can Do
Know Your Risks and Monitor Your Health
Ask your health care provider about your transfusion history and risk of developing hepatitis.
Share a copy of your survivorship care plan, which includes a treatment summary and information about transfusion.
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 active infection.
- Survivors with hepatitis B or C should visit a liver or infectious disease specialist for evaluation and treatment.
- Tell the doctor about all over-the-counter medications and supplements you are taking.
- Do not drink alcohol.
- Avoid over-the-counter medications containing acetaminophen (such as Tylenol®.)
- 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 the liver.
- 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.)
Maintain good liver health
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.
- Avoid mixing drugs and alcohol.
- Avoid mixing herbs and natural supplements with medications.
- Avoid exposure to solvents, aerosol cleaners, insecticides, paint thinners, and other toxins.
Prevent spread of hepatitis
Survivors with 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.
- Never share personal care items that may come in contact with blood such as razors, toothbrushes, nail clippers, earrings, and rings on other parts.
- 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.