Major risk of blood transfusion in hemolytic anemia patients

Abstract

Thalassemia is a congenital hemolytic disease caused by defective globin synthesis treated by blood transfusion. Transfusion-transmitted infections still make a great challenge in the management of patients with thalassemia major. The most important worldwide transfusion-transmitted infections are hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV. The objective of this study is to update the prevalence of the three major transfusion-transmitted infections HCV, HBV and HIV among thalassemic patients followed up in the Hematology Department, Children Hospital, Cairo University. The study included 174 multitransfused thalassemic patients (162 major and 12 intermedia), registered at the Pediatric Hematology Clinic, Cairo University. Their age ranged from 2 to 27 years with a mean of 11.26 ± 5.4 years. Patients were subjected to full history taking, stressing on history of blood transfusions (onset, frequency and duration) at a single or multiple centers and abdominal examination. Laboratory investigations including complete blood count, aminotransferases (aspartate aminotransferase and alanine aminotransferase), ferritin and viral markers of HBV surface antigen (HBsAg), HCV antibodies (anti-HCV) and anti-HIV were assayed for all cases by a third-generation ELISA method. HCV PCR was performed for 75 cases. Of the 174 patients, none of them were HBsAg and anti-HIV positive. However, 90 patients were anti-HCV positive (51.7%). HCV PCR was positive in 56 patients (74.3%) of the 75 with positive antibody tested. HCV antibody positivity is statistically significant with age of the patient, serum ferritin and liver transaminases (P < 0.01). HCV-RNA by PCR positivity was significantly related to patients' age and serum ferritin (P < 0.05). Serum ferritin showed statistically significant positive correlation with liver transaminases. Despite the decrease in prevalence of HCV antibody in our patients from 71% in 1995 to 51.7% in our study, yet HCV infection still represents a major health problem for our thalassemic patients, which requires more attention and efforts to challenge. There is a dramatic decrease in the prevalence of HBV infection over the last decade, thanks to mass compulsory vaccination and blood screening. HIV infection does not represent a problem owing to very low population prevalence.

The Prevalence of Hepatitis B and C Viruses Among Blood Donors Attending Blood Bank in Duhok, Kurdistan Region, Iraq

“…None of the HCV-antibody-positive subjects had a positive family history. This might be due to the low infectivity rate of this virus as it was reported that the chance of getting the infection after an exposure is only 3%; while it is 30%-60% in HBV, depending on the HBe antigen positivity (35,39,40).…”

“…It was also previously shown that HBsAg can be found in all body secretions and excretions. However, only blood, vaginal and menstrual fluids, and semen are infectious (35,39,40). HBV can stay active in the environment for up to seven days.…”

“…Certain types of behaviours increase the risk of contracting HBV and HCV infections; for example, use of contaminated needle during acupuncture, intravenous drug abuse (32), ear piercing and tattooing (33), heterosexuals or homosexuals sexual activities (especially for HBV) (34), infants born to infected mothers (35), healthcare providers (36,37), subjects undergoing haemodialysis (38) and patients with haemoglobinopathy (39). It was previously shown that HBV can be transmitted sexually and vertically from mother to new born baby.…”

Hepatitis B Knowledge Among Healthy Volunteers in Duhok City, Kurdistan Region, Iraq

“…This puts extra burden on the thriving health systems in the developing countries such as Iraq. The risk factors associated with HBV infection are surgical operations and dental surgeries, history of blood and blood product transfusion, undergoing renal hemodialysis, drug abuse, and certain sexual behaviors (4)(5)(6)(7)(8). In Duhok city, Iraq, healthcare providers have set a plan to eradicate HBV by 2030.…”

Deranged liver enzyme status in thalassemicpaediatric patients- is it hepatitis or iron overload?

“…[6,7] Long-term observation of thalassemics who had undergone bone marrow transplantation (BMT) showed that severe iron overload and chronic HCV infection were independent risk factors for liver injury. [8] Hepatitis virus C infection is the main risk factor for liver injury in transfusion-dependent thalassemics. [9] Dimitrios et al (2013) [10] on the other hand suggested that in the late stages of liver disease in BTM patients, iron overload may be the critical determinant, since fibrosis is related to the minimal haemosiderosis, independently of HCV history.…”