Impact of pooling on accuracy of hepatitis B virus surface antigen screening of blood donations

L. Novack, B. Sarov, R. Goldman-Levi, V. Yahalom, J. Safi, H. Soliman, M. Orgel, A. Yaari, N. Galai, J. S. Pliskin, E. Shinar

Research output: Contribution to journalArticlepeer-review


Expenditure on screening blood donations in developing countries can be reduced by testing donations in pools. This study evaluated serological screening in pools for hepatitis B virus (HBV) at the Israeli national blood bank and a hospital blood bank in Gaza, the Palestinian Authority. The accuracy of HBV surface antigen (HBsAg) enzyme immunoassay performed on pools of 3-24 samples was compared with individual tests. Delay in detecting positive samples due to dilution in pools and the possibility of antibody-antigen neutralization were analyzed. The sensitivity of pooled testing for HBsAg was 93-99%, prolonging the window period by 5 days (8.3%). Neutralization of HBsAg by hepatitis B surface antibodies (anti-HBs) could be minimized by testing immediately after pooling. Serological testing for HBsAg in pools may be performed using manually created pools of up to six samples, with 5% loss in sensitivity and a risk of neutralization by anti-HBs present in the donor population. Pooling can therefore be considered as an option only in countries with a low prevalence of HBV.

Original languageEnglish
Pages (from-to)787-792
Number of pages6
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Issue number8
StatePublished - Aug 2008

Bibliographical note

Funding Information:
This research was supported by the U.S. Agency for International Development, Middle East Regional Cooperation (AID-MERC), Washington, DC, USA (project number M18-004).


  • Antibody
  • Antigen
  • Blood donation
  • Hepatitis B
  • Hepatitis B virus surface antigen
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Parasitology

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