Deranged liver enzyme status in thalassemic paediatric patients- is it hepatitis or iron overload?
Keywords:
Hepatitis, ferritin, SGOT, SGPT
Abstract
INTRODUCTION:The susceptibility to infections in thalassemia arises from a large spectrum of immunological abnormalities and from the exposure to infectious agents by allogenic blood transfusions. Increased hepatic iron may potentiate progression towards liver fibrosis in chronic HCV infection and may contribute to poor response to therapyOBJECTIVE: (1)To determine the prevalence of hepatitis B and hepatitis C in thalassemic paediatric patients. (2) To determine the relationship between elevated liver enzymes with serum ferritin and viral hepatitis in thalassemia.METHOD: Sera was obtained from 100 thalassemia children and was processed for anti-HCV and HBsAg, serum ferritin,ALT/SGPT & AST/SGOTRESULTS:100 subjects were evaluated. Eight subjects (8%) were HBsAg positive and six (75%)received more than 100 blood transfusions.Out of these eight subjects with, seven had raised SGOT, & six had raised SGPT. Four subjects were positive for hepatitis C & all of them (100%) received more than hundred blood transfusions.All four HCV subjects had raised SGOT & SGPT (p=0.037).SGOT was raised in 68% subjects and 47 (69%) had more than 100 blood transfusions (p=0.002). SGPT was raised in 49% subjects and 37 (75.5%) had more than 100 blood transfusions. 86% subjects had serum ferritin in range of 1000-2000ng/ml & 14% had serum ferritin <1000 ng/ml.Serum ferritin showed strong correlation with SGOT & SGPT (p=0.036 & p=0.002).CONCLUSIONS:Prevalence of hepatitis B in Thalassemic’s in our study was 8% while hepatitis B in general population is 4.35%. Hepatitis C was 4% in our study while that in children in general population is 0.31%. Serum ferritin showed significant correlation with SGOT & SGPT. This finding suggests that iron overload is one of the major causes of abnormal liver function in subjects with thalassemia.So the treatment of hepatitis as well as iron overload should be done to prevent progression to liver disease. DOI:10.21276/APALM.1616References
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27.Ocak S ,Kaya H ,Cetin M,GaliE,OzturkM.Seroprevalence of Hepatitis B &Hepatitis C in patients with thalassemia and sickle cell anemia in a long term follow up.Archives of medical Research 2006;37(7);895-98.
28.WanachiwanawinW, LuengrojanakulP,Sirangkapracha P et al .Prevalence & Clinical significance of Hepatitis C virus infection in Thai patients with Thalassemia.Int.JHematol 2003;78(4):374-78.
29. Angelucci E, Muretto P, Nicolucci A, et al. Effects of iron overload and HCV positivity in determining progression of liver fibrosis in thalassaemia following bone marrow transplantation. Blood. 2002;100:17–21.
30.Omar, Naglaa, Salama, Khaleda, Adolf, Sonyab, El-Saeed, GamilaSM, Ghaffar A,Nazwad, Ezzat, Nivind. Major risk of blood transfusion in hemolytic anaemiapatients. Blood Coagulation & Fibrinolysis.2011;22(4)280-284.
2. Karimi M, Ghavanini AA, and Kadiva MR. Regional mappin the Gene frequency of β-Thalassemia in Fars Province, during 1997-1998. Iran J Med Sci. 2000; 25(3&4):134-137.
3. Ameli M, Besharati S, Nemati K, Zamani F. Relations between elevated liver enzyme with iron overload and v hepatitis in thalassemia major patients in Northern Iran. Sa Med J. 2008; 29(11):1611-5.
4.Ardalan FA, Osquei MR, Toosi MN, Irvanloo G. Synergic e of chronic hepatitis C infection and beta thalassemia m with marked hepatic iron overload on liver fibrosis: retrospective cross-sectional study. BMC Gastroente 2004; 4:17.
5. Papanikolaou G, Tzilianos M, Christakis JI, Bogdanos D et Hepcidin in iron overload disorders. Blood. 2005; 105: 4103- 4105.
6. Feld J, Lee JY, Locarnini S. New targets and possible new therapeutic approaches in the chemotherapy of chronic hepatitis B. Hepatology. 2003;38(3):545–53.
7.Khalifa AS, El-Sayed MH, Moustafa AO, Mohammed MM, Rady MS, Salama II. Hepatitis C virus infection in children with hematological diseases: risk factors and reliability of diagnosis assays. Egypt J Pediatr. 2002;19: 293–308.
8.Omar N, Salama K, Adolf S, El-Saeed GS, et al. Major risk of blood transfusion in hemolytic anemia patients. Blood Coagul Fibrinolysis. 2011; 22(4): 280–4.
9.El-Faramawy A, El-Rashidy O, Tawfik P, Hussein G. Transfusion Transmitted Hepatitis: Where Do We Stand Now? A One Center Study in Upper Egypt. Hepat Mon. 2012;12(4): 286-291.
10.Li CK, Chik K, Lam C, To K et al., Liver disease in transfusion dependent thalassemia major. Arch Dis Child. 2002; 86:344-7.
11.Cunningham M, Macklin E, Neufeld E, Cohen AR. Thalassemia Clinical Research Network. Complications of β- thalassemia major in North America. Blood. 2004; 104:34-39. dependent thalassemics: the role of iron overload and chronic hepatitis C. Haematologica. 2008; 93(8):1243–1246.
12. Feld J, Lee JY, Locarnini S. New targets and possible new therapeutic approaches in the chemotherapy of chronic hepatitis B. Hepatology. 2003;38(3):545–53.
13. Lin YY, Qiang F, Shun ZM, Jie C, Ming MG ,Hu HZ, Bing CX. Virology Journal 2012,9(82). Pourazar A, Salehi M, Jafarzadeh A,Arababadi M K,Oreizi F,Shariatinezbad.IJI.2005;2(3).
14. Alter H J. To C or not to C:these are the questions.Blood.1995;85:1681-1695.
15. Olivieri NF, Brittenham GM. Ironchelating therapy and the treatment of thalassemia. Blood. 1997;89:739–61.
16. OamerS,ShahabT,AlamS,MalikA,AfzalK.Age specific prevalence of hepatitis B surface antigen in pediatric population of Aligarh,North India Indian J. Pediatr.2004 ;71 (11) :965-17. Mansour AK, Aly RM,Abdeliazek SY,Elghannam DM, Abdelaziz SM,Shahine DA, Elmenshawy NM,Darwish AM.Hematol Oncol stem cell Ther,2012;5(1):54-9.
18. Yuan Q,Qu SH,Chen CR,Ge SX,Pei B,Chen QR,Yan Q,Lin Y C,Ni HY,Huang CH et al.Journal of Clinical Microbiology 2010,48 (2)357-362.
19. Torane VP, Shastri JS (2008) Comparison of ELISA and rapid screening tests for the diagnosis of HIV, hepatitis B and hepatitis C among healthy blood donors in a tertiary care hospital in Mumbai. Indian J Med Microbiol 26: 284-285.
20. Busch MP (2004) Should HBV DNA NAT replace HBsAg and/or anti-HBc screening of blood donors? Transfus Clin Biol 11: 26-32.
21. Iqbal HS, Solomon S, Murugavel KG, Solomon SS, Balakrishnan P (2005)Evaluation and diagnostic usefulness of domestic and imported enzyme-linked immunosorbent assay for the detection of HIV type 1 antibody inIndia. Clin Diagn Lab Immunol 12: 1425-1428.
22. World Health Organization (WHO) (2007) Status of blood safety in the WHO African Region. Report of the 2004 Survey WHO Regional Officefor Africa, Brazzaville.
23. Kuhns MC, Busch MP (2006) New strategies for blood donor screening for hepatitis Bvirus: nucleic acid testing versus immunoassay methods.Mol Diagn Ther 10: 77-91.
24. Vermeulen M, Lelie N, Sykes W, Crookes R, Swanevelder J et al. (2009) Impact of individual-donation nucleic acid testing on risk of human immunodeficiency virus, hepatitis B virus, and hepatitis C virustransmission by blood transfusion in South Africa. Transfusion 49:1115-1125.
25. Zhu H, Li G, Lv M, Wu D, Li X (2013) A pilot study on screening blooddonors with individual-donation nucleic acid testing in China. BloodTransfus 23: 1-8.
26. Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Chaudhuri S, Maity SG, Naik TN, Bhattacharya SK, Mazumder DN. Hepatitis C virus infection in the general population: a community-based study in West Bengal, India.Hepatol 2003; 37:802-09.
27.Ocak S ,Kaya H ,Cetin M,GaliE,OzturkM.Seroprevalence of Hepatitis B &Hepatitis C in patients with thalassemia and sickle cell anemia in a long term follow up.Archives of medical Research 2006;37(7);895-98.
28.WanachiwanawinW, LuengrojanakulP,Sirangkapracha P et al .Prevalence & Clinical significance of Hepatitis C virus infection in Thai patients with Thalassemia.Int.JHematol 2003;78(4):374-78.
29. Angelucci E, Muretto P, Nicolucci A, et al. Effects of iron overload and HCV positivity in determining progression of liver fibrosis in thalassaemia following bone marrow transplantation. Blood. 2002;100:17–21.
30.Omar, Naglaa, Salama, Khaleda, Adolf, Sonyab, El-Saeed, GamilaSM, Ghaffar A,Nazwad, Ezzat, Nivind. Major risk of blood transfusion in hemolytic anaemiapatients. Blood Coagulation & Fibrinolysis.2011;22(4)280-284.
Published
2018-02-27
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