SCREENING FOR HEPATITIS B & C: A ROUTINE PREOPERATIVE INVESTIGATION? Zubia Masood 1 , Masood Jawaid 2 , Rehan Abbas Khan 3 & Shafiq ur Rehman 4 ABSTRACT Objective: To find out the seroprevalence of HBsAg and Anti-HCV and to evaluate associated risk factors in patients admitted for elective surgery in a tertiary care public hospital of Karachi. Design: Descriptive serological analysis. Setting: Surgical Unit IV, Civil Hospital, Karachi. Patients and Methods: All patients admitted for elective surgery from February 1, 2004 to September 30, 2004 were included. HBsAg and Anti HCV screening was done in all patients with Enzyme Linked Immunosorbent Assay (ELISA) during the preoperative period. The information was collected by a specially designed proforma that included current and previously known hepa- titis profile, risk factors and history of vaccination apart from demographic data. Main Outcome Measures: Seroprevalence of HBsAg and anti HCV, different risk factors. Results: A total of 387 patients were admitted for elective surgical procedure during the study period. It included 221 (57.1%) males and 166 (42.9%) females. After screening HBsAg was posi- tive in 25 (6.5%) of patients, anti HCV in 44 (11.3%) of patients while 6 (1.5%) were positive for both HBsAg and anti HCV. A vast majority of patients gave history of frequent use of intravenous and intramuscular medication i.e. 24 (96%) in HBsAg positive and 42 (95.5%) for anti HCV posi- tive patients, followed by blood transfusion where HBV seropositivity was found in 21 (84.0%) while HCV seropositivity was in 38 (86.3%). History of previous surgical procedures was present in 15 (60%) of HBsAg positive and 28 (63.6%) of Anti HCV positive patients. History of jaundice was present in 12 (48.0%) in HBV seropositive and 22 (50%) in HCV seropositive patients. Three patients were previously known seropositive for hepatitis B and two for hepatitis C. None of patients had vaccination against hepatitis B. Conclusion: The prevalence of HBsAg and anti-HCV in hospitalized surgical patients is very high. There is lack of routine serological screening in our hospitals prior to surgery. A protocol should be developed and implemented whereby screening for Hepatitis B and C should be a routine pre operative investigation. The major risk factors include re-use of contaminated syringes, con- taminated surgical instruments and blood products. KEY WORDS: HBsAg, anti-HCV, seroprevalence, surgical patients. Pak J Med Sci October-December 2005 Vol. 21 No. 4 455-459 INTRODUCTION Hepatitis B and C virus (HBV & HCV) are known cause of infectivity leading to signifi- cant morbidity and mortality world wide es- pecially in the developing countries like Paki- stan 1 . The hepatitis B virus (HBV) was first iso- lated in 1963. 2 It has infected over two billion individuals world wide. More than 520,000 die each year from HBV related acute and chronic liver disease. 3 The hepatitis B surface antigen (HBsAg), a serological marker for HBV was first demonstrated by Blumberg in 1963, 4 while hepatitis C was first cloned in 1989. 5,6 Nearly 1. Dr. Zubia Masood MBBS Postgraduate Student 2. Dr. Masood Jawaid MBBS Postgraduate Student 3. Dr. Rehan Abbas Khan FCPS, FRCS Resident Medical Officer 4. Prof. Shafiq-ur-Rehman FRCS Prof. of Surgery 1-3. Surgical Unit IV, 4. Surgical Unit VII, Dow University of Health Sciences and Civil Hospital Karachi. Correspondence: Dr. Zubia Masood E-mail: drzubi77@hotmail.com * Received for publication: June 1, 2005 Accepted: August 5, 2005 Pak J Med Sci 2005 Vol. 21 No. 4 www.pjms.com.pk 455