Clinicovirologic analysis of hepatitis C infection in transfusion‐dependent β‐thalassemia major children

Abstract

Regular blood transfusion puts beta-thalassemia major patients at a higher risk of developing hepatic iron overload and hepatitis C virus (HCV) infection. The association between several transfusion-related factors and an increased risk of developing HCV viremia has been reported. The effect of HCV infection on liver damage in transfusion-dependent thalassemia patients has been poorly described. A sample of 100 Egyptian transfusion-dependent beta-thalassemia major children were studied. Individual patients underwent full history taking, clinical examination and a panel of laboratory tests including HCV ribonucleic acid polymerase chain reaction (HCV-PCR) in blood samples. Liver biopsy was performed for 24 patients. HCV-PCR was positive in 64% of patients. A statistically significant correlation was found between HCV-PCR positivity (HCV viremia) and shorter inter-transfusion interval. There was a significant positive correlation between mean serum ferritin level and mean levels of alanine aminotransferase and aspartase aminotransferase. Histopathologic features of both chronic hepatitis and siderosis were present in 91.7% of biopsy specimens, and fibrosis was present in 41.67%. A higher risk of HCV viremia is noted with a shorter inter-transfusion interval. The reduced role of HCV infection in chronic liver injury in this group of patients may be surpassed by the associated effects of iron overload because of the chronic transfusion. However, the latter finding should be verified in larger studies.

Occult hepatitis B in Egyptian thalassemic children

“…This observation is differs from our results, and the discrepancy may possibly be due to the difference in prevalence of these infections in the donating blood pool population as patients from countries highly endemic for HBV are more likely to develop occult HBV infections [21]. Our results showed an increased prevalence of occult HBV infection in patients older than six years of age, who have had a higher number of blood transfusions than younger patients, and these observations are similar to those of many other reports [9,4,14]. In our study, the majority of the patients were males, representing 67.4% of the subjects, which is similar to observations of male preponderance in such infections in other investigations [7,4].…”

“…A recently published study on Egyptian transfusion-dependent beta-thalassemia major children showed that HCV-PCR in liver biopsy was positive in 64% of patients [14]. Others reported 45% of their thalassemia patients positive for HCV-RNA [15].…”

“…Ragab et al [14] reported a significant positive correlation between mean serum ferritin level (representing iron load from multiple transfusions) and mean levels of ALT and AST.…”

Longitudinal Study on Liver Functions in Patients With Thalassemia Major Before and After Deferasirox (Dfx) Therapy

“…HCV infected patients had significantly higher enzymes than non-infected 13. chronic hepatitis C virus infection has been associated with liver iron loading.…”

Serum YKL-40 Levels and Chitotriosidase Activity in Patients with Beta-Thalassemia Major

“…Life-long transfusion regimens are essential to alleviate anaemia. Although regular blood transfusions have largely improved the prognosis, iron overload, especially in the liver (liver siderosis), and high risk of hepatitis C infections constitute a real threat to the quality of life of beta-thalassemia patients [19]. In beta-thalassemia patients both iron overload and HCV-related liver disease lead, albeit through different mechanisms, to hepatocellular necrosis, fibrosis, and cirrhosis.…”