Paper II — 2022 October (Supplementary) (2010 Scheme) — Q1
5 min read
Paper II
2022 October (Supplementary) (2010 Scheme) · 40 marks · 120 min
Question
An adult male aged 26 years was suffering from severe anemia due to iron deficiency.
He was given blood transfusions to correct anemia. Two months later, he developed
yellowishness of the sclera and also complained of passing high coloured urine.
Answer the following:
Name the probable etiologic agents.
What are the other modes of transmission of this agent.
How will you proceed with the laboratory diagnosis.
How will you protect the individual from acquiring this infection (2+2+5+1)
Q110 marksEssays
Answer
Probable etiologic agents: Hepatitis viruses transmitted via blood transfusion — primarily Hepatitis B virus (HBV) and Hepatitis C virus (HCV) (Hepatitis D virus, HDV, is also transmitted parenterally, but requires co-infection with HBV) — jaundice and dark (high-coloured) urine appearing two months after a blood transfusion is classical for transfusion-transmitted viral hepatitis, with this incubation period fitting both HBV (typically 1–4 months) and HCV (typically 2 weeks–6 months).
Sexual contact — a well-established route for HBV; a less efficient but recognized route for HCV.
Vertical (perinatal) — mother-to-child transmission, particularly for HBV, and a significant transmission route in endemic regions.
Laboratory diagnosis
For HBV: HBsAg (current infection), IgM anti-HBc (recent/acute infection), HBeAg (active replication/high infectivity), HBV DNA (quantitative PCR) (most direct marker of viral replication); anti-HBs and IgG anti-HBc for assessing immunity/past infection.
For HCV: anti-HCV antibody (ELISA) — screening test, though it does not distinguish current from past/resolved infection; HCV RNA (quantitative PCR) — confirms current active infection and is essential since a positive antibody test alone cannot confirm ongoing infection.
Liver function tests — raised ALT/AST reflecting hepatocellular injury; raised bilirubin (explaining the jaundice and dark urine — conjugated bilirubin excreted in urine).
Liver biopsy/elastography — for assessing fibrosis in chronic infection, not for acute diagnosis.
Protection from acquiring this infection: rigorous screening of blood/blood products before transfusion (mandatory testing for HBsAg, anti-HCV, and other transfusion-transmissible infections) — the single most important preventive measure directly relevant to this patient’s transfusion-related exposure; HBV vaccination is also available and highly effective (no vaccine currently exists for HCV), and would be a relevant prophylactic measure against HBV specifically for individuals anticipating repeated transfusions.
