March 19, 1996
Transmission (HCV); Alternative Medical Procedures Can Spread
Blood Weekly via Individual Inc. : Alternative medical procedures
involving autologous blood may transmit hepatitis C virus (HCV).
Invasive medical procedures, particularly those performed in
non-medical settings, require careful review, stated Christian
Gabriel, Red Cross Transfusion Service of Upper Austria, Linz,
Austria, and colleagues. Gabriel et al. described two cases
involving alternative medical procedures in which HCV may have been
transmitted ("Transmission of Hepatitis C by Ozone Enrichment of
Autologous Blood," Lancet, 1996;347:541).
Both patients - a 56-year-old woman and a 57-year-old man -
presented with jaundice within 7 days of each other. Both had
elevated alanine aminotransferase (ALT) levels and polymerase chain
reaction (PCR) testing revealed HCV infection with genotype 1b in
both the patients. After symptomatic treatment, the two patients
were discharged with ALT values near normal after three weeks.
Upon extensive questioning, the authors learned that both
patients had visited the same non-medical practitioner in Bavaria 8
and 4 weeks before admission to hospital. In Bavaria, each had
undergone treatment by ozone- enrichment of blood, a procedure in
which citrated autologous blood is foamed up with oxygen, treated
in a quartz-glass container with UV-B radiation, then reinjected.
In Austria non-medical practitioners are not licensed, and to
obtain alternative medical procedures patients go to Bavaria,
Gabriel et al. noted. "The source of infection in these cases may
have been the reusable quartz- glass container which was only
disinfected with an alcoholic solution after ozone enrichment of
blood," wrote Gabriel et al. "German health authorities have
ordered the sterilization of reusable parts used by this
The courts in Munich have received reports of five additional
cases of HCV transmission under the same circumstances, Gabriel et
al. said. "Invasive medical procedures, even with autologous blood,
should be carefully reviewed for the transmission of HCV,
especially in non-medical settings," Gabriel et al. wrote.
They noted that the source of infection is not known in 40
percent of acute hepatitis C cases (van der Poel, Curr Stud Hematol
Blood Transfus, 1994;137:163).
The female patient, who was referred to the hospital for
intensifying jaundice, had an elevated ALT of 1529 IU/L and total
bilirubin of 128 (micro)mol/L. She had a positive anti-HCV test
result, but test results for other forms of viral hepatitis were
The male patient presented at the hospital 7 days later with
acute onset of jaundice. His total bilirubin was 244 (micro)mol/L;
his ALT was 1878 IU/mL). All viral indices, including anti-HCV,
The researchers performed HCV reverse transcriptase-polymerase
chain reaction (RT-PCR) of the 5'non-coding region, and the result
was positive. The hybridization of PCR-products (LIPA) revealed
that both patients had an infection with genotype 1b
(Stuyver et al., J Gen Virol, 1993;74:1093-1102). The
corresponding author for this study is Christian Gabriel, Red Cross
Transfusion Service of Upper Austria, A-4017 Linz, Austria.
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