Hepatitis B and C

Hepatitis B and C are viruses that affect the liver. They matter in thalassaemia for one historical reason: before blood could be reliably screened for them, they were sometimes passed on in transfusions. Modern donated blood is tested, so new infections through transfusion are now rare — but people transfused in earlier decades may carry an infection acquired long ago, often without ever feeling ill.

Hepatitis B — the one you can be protected from

There is a vaccine, and it works. It is recommended for everyone with thalassaemia who is not already immune, ideally before regular transfusions begin.

Two things follow from that:

• Your antibody level is rechecked over time, because protection can fade and a booster may be needed. Being vaccinated once as a child does not guarantee you are still covered.
• If you were never vaccinated, an annual blood test for hepatitis B is recommended instead.

Hepatitis C — worth being tested for, because it is now curable

There is no vaccine for hepatitis C, but there is something better: modern tablet treatments cure the large majority of people, usually in a few months, with far fewer side effects than the older injections many people remember or were warned about.

Testing is done in two steps. An antibody test shows whether you have ever been exposed; if it is positive, a second test looks for the virus itself, because many people clear it naturally and no longer carry it. Anyone transfused before the early 1990s should be tested at least once, even if they feel completely well.

If you were told years ago that you had hepatitis C and treatment was hard or unavailable then, it is genuinely worth asking again. The situation has changed.

Why the liver is scanned

Long-standing viral infection and iron loading both stress the liver over years, and in people who have developed scarring the liver is checked by ultrasound about every six months. That is surveillance, not suspicion — it exists so that anything is found early, when it is most treatable.

Iron control and hepatitis care work together here. Keeping iron down protects the liver you have, whatever its history.