The combined effects of stringent donor selection criteria, HCV antibody testing of donated blood, minipool HCV PCR testing and the use of dual viral elimination methods has resulted in extremely low residual risk of HCV transmission. Recombinant factor products are free from the risk of HCV transmission as they do not contain material Vemurafenib obtained from human blood. The majority of

patients exposed to blood components and factor concentrates prior to the introduction of viral inactivation procedures in the mid 1980s will have been tested for HCV infection at their treatment centres. However, it is likely that there are a significant number of patients with mild disorders who have received concentrate on a single or several occasions and contracted HCV but have not been followed up and tested. All patients with bleeding disorders who received blood products before 1992 should be tested for HCV antibody using a third generation ELISA www.selleckchem.com/products/Rapamycin.html test. Patients who are HCV antibody positive should undergo

HCV RNA PCR testing to determine whether or not they have naturally cleared their infection. RNA PCR positive patients should be referred to a hepatologist for further assessment including RNA quantitation, HCV genotyping and for assessment of the stage of liver damage. HCV RNA negative patients who have cleared the infection naturally should be counselled but long-term hepatology follow up is not required. Biomarkers.  A number of algorithms based on biochemical test results including the aspartate aminotransferase to platelet ratio index (APRI score), Fibrometer, FIB-4 and Fibrotest have been developed to predict the severity of the liver disease [8–11]. For example, the Fibrotest combines the following medchemexpress parameters in a patented algorithm to derive a score which correlates with liver disease severity: age, gender, alpha-2-macroglobulin, haptoglobin, gamma-GT, total bilirubin and apolipoprotein A1. These non-invasive methods,

however, have limited value. Whilst they are useful in defining patients with cirrhosis or with only mild liver disease, they are not useful in the assessment of intermediate stages of disease which the majority of patients have [12]. Few studies have been performed assessing these methods in HCV infected haemophilia patients. Maor et al. compared Fibrotest and Fibroscan (see below) assessment of the stage of liver disease in 57 haemophilic patients with active HCV infection and reported reasonable correlation in patients with cirrhosis but poorer concordance in those with milder degrees of fibrosis [13]. Vidovic et al. combined APRI and FIB-4 assessments in 174 HCV infected haemophilia patients and demonstrated good correlation with the stage of liver disease as determined by Fibroscan score. Again the concordance rates were highest in patients with cirrhosis [14]. Transient elastography.