Unrecognized hepatitis B in pre-screened children with hematologic and oncologic conditions

Background This study evaluates the effectiveness and interpretation of hepatitis B (HBV) screening in an at‐risk cohort of children with cancer or blood disorders. Procedure We conducted a retrospective epidemiologic analysis of children who screened positive for HBV (HBsAg, HbcAb) from 1999 to 2009 at a quaternary children's hospital, focusing on patients with hematologic and oncologic conditions. Descriptive statistics were generated for demographics and serologies. Follow‐up of positive serologies and clinical outcomes were analyzed. Results A total of 12,754 children were screened for HBV. Of 391 that screened positive, 118 had a hematologic or oncologic diagnosis. Leukemia, anemia, and thrombocytopenia comprised 84% of diagnoses. The majority (98%) tested HBcAb positive but only 20% received confirmatory HBV DNA testing. Three patients (13% of those HBV DNA tested) were identified to have chronic disease. HBV was not a known pre‐existing condition, and chemotherapy preceded HBV diagnosis in all cases. Conclusions The majority of children with cancer or blood disorders who screened HBV positive did not receive follow‐up DNA testing, exposing them to reactivation risk and delaying definitive therapy. HBcAb may be the only indicator of chronic HBV infection and DNA confirmation should be routine. Our findings suggest a significant number of additional patients eligible for HBV treatment may have been identified with reflexive DNA testing. Pediatr Blood Cancer 2014;61:865–868. © 2013 Wiley Periodicals, Inc.