Prevalence of hepatitis and its correlation with serum ferritin and aminotransferase levels among thalassemia major patients in Indonesia
Abstract
Background Thalassemia major patients who undergo routine transfusion have an increased risk of acquiring transfusion-transmitted infections (TTI), including hepatitis B and C. These diseases have serious implications and may affect the serum ferritin and aminotransferase levels of thalassemia major patients.
Objectives To identify the prevalence of hepatitis B and/or C infections among thalassemia major patients and to evaluate its correlation with serum ferritin and aminotransferase levels.
Methods This was across-sectional study conducted at the Thalassemia Center of Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia. The subjects were screened for hepatitis B and C infections, and their serum ferritin and aminotransferase levels were also measured.
Results In total, 621 subjects were included in the study, among which 5 subjects tested positive for hepatitis B surface antigen (HBsAg) (0.8%), 111 subjects tested positive for anti-HCV (17.8%), and 5 subjects tested positive for both HBsAg and anti-HCV (0.8%). The subjects who tested positive for hepatitis B, hepatitis C, or both showed significantly higher values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum ferritin compared to their negative counterparts. Moreover, serum ferritin showed a positive, moderate correlation with both AST and ALT.
Conclusion This study shows a significant association between hepatitis and serum ferritin as well as aminotransferase levels. Early detection and early management of hepatitis B and C infections is warranted to minimize the occurrence of liver damage in thalassemia major patients.
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References
US Public Health Service. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. 2001;50:1–52.
Alter MJ. Epidemiology of hepatitis C virus infection. World J Gastroenterol. 2007;13:2436–41.
Okada S, Taketa K, Ishikawa T, Koji T, Swe T, Win N, et al. High prevalence of hepatitis C in patients with thalassemia and patients with liver diseases in Myanmar. Acta Med Okayama. 2000;54:137-8.
Borgna-Pignatti C, Rugolotto S, De Stefano P, Zhao H, Cappellini MD, Del Vecchio GC, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haemotologica. 2004;89:1187-93.
Ladis V, Chouliaras G, Berdoukas V, Chatziliami A, Fragodimitri C, Karabatsos F, et al. Survival in a large cohort of Greek patients with transfusion-dependent beta thalassaemia and mortality ratios compared to the general population. Eur J Haematol. 2011;86:332-8.
Riaz H, Riaz T, Ullah F, Aziz S, Khan MU, Pervaiz R, et al. Assessment of the seroprevalence of viral hepatitis B, viral hepatitis C, and HIV in multitransfused thalassemia major patients in Karachi, Pakistan. Trop Doct. 2011;41:23-5.
Soedarmono YS. Donor issues in Indonesia: a developing country in South East Asia. Biologicals. 2010;38:43-6.
Jaiswal SP, Chitnis DS, Jain AK, Inamdar S, Porwal A, Jain SC. Prevalence of hepatitis viruses among multi-transfused hemogenous thalassemia patients. Hepatol Res. 2001;19:247-53.
Purnamawati SP, Kartoyo P, Chair I, Bisanto J, Oswari H. Profile of alanine aminotransferase and hepatic iron accumulation in thalassemic patients with or without anti-hepatitis C virus. Paediatr Indones. 2004;44:85-9.
Din G, Malik S, Ali I, Ahmed S, Dasti JI. Prevalence of hepatitis C virus infection among thalassemia patients: a perspective from a multi-ethnic population of Pakistan. Asian Pac J Trop Med. 2014;7:S127-33.
Wanachiwanawin W, Luengrojanakul P, Sirangkapracha P, Leowattana W, Fucharoen S. Prevalence and clinical significance of hepatitis C virus infection in Thai patients with thalassemia. Int J Hematol. 2003;78:374-8.
Vidja PJ, Vachhani JH, Sheikh SS, Santwani PM. Blood transfusion transmitted infections in multiple blood transfused patients of beta thalassemia. Indian J Hematol Blood Transfus. 2011;27:65-9.
Shao H, Li Y, Xu WZ, Zhou X. Increased need for testing to confirm initial weakly reactive results for hepatitis B virus surface antigen. Lab Med. 2012;43:15-7.
Bonkovsky HL, Banner BF, Rothman AL. Iron and chronic viral hepatitis. Hepatology. 1997;25:759-68.
Bassett SE, Di Bisceglie AM, Bacon BR, Sharp RM, Govindarajan S, Hubbard GB, et al. Effects of iron loading on pathogenecity in hepatitis C virus-infected chimpanzees. Hepatology. 1999;29:1884-92.
Shan Y, Lambrecht RW, Bonkovsky HL. Association of hepatitis C virus infection with serum iron status: analysis of data from the Third National Health and Nutrition Examination Survey. Clin Infect Dis. 2005;40:834-41.
Shaker O, Ahmed A, Abdel SI, El Ahl H, Shousha W, Doss W. Occult hepatitits B in Egyptian thalassemic children. J Infect Dev Ctries. 2012;6:340-6.
Singh H, Pradhan M, Singh RL, Phadke S, Naik SR, Aggarwal R, et al. High frequency of hepatitis B virus infection in patients with beta-thalassemia receiving multiple transfusions. Vox Sang. 2003;84:292-9.
Alavian SM. Occult hepatitis B in thalassemia: a need for further study. J Infect Dev Ctries. 2012;6:650-1.
Triantos C, Kourakli A, Kalafateli M, Giannakopoulou D, Koukias N, Thomopoulos K, et al. Hepatitis C in patients with β-thalassemia major: a single-centre experience. Ann Hematol. 2013;92:739-46.
Azarkeivan A, Hashemieh M, Akhlaghpoor S, Shirkavand A, Yaseri M, Sheibani K. Relation between serum ferritin and liver and heart MRI T2* in beta thalassemia major patients. East Mediterr Health J. 2013;19:727-32.
Ananta Y, Wahidiyat PA, Oswari H. Deferiprone effectiveness in thalassemia major children with or without hepatitis Bo r C virus infection: a non-randomized study. Paediatr Indones. 2010;50:105-12.
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Accepted 2017-07-20
Published 2018-01-05
