Profile of alanine aminotransferase and hepatic iron accumulation in thalassemic patients with or without anti-hepatitis C virus
Abstract
Background Repeated blood transfusions in thalassemic patientscause iron accumulation in tissues and might impair organ func-
tion. Other peril of blood transfusion is hepatitis C virus infection.
Objectives This study aimed to find out the proportion of increased
alanine aminotransferase (ALT), increased transferrin saturation
(TS), and positive anti hepatitis C virus (anti-HCV) among thalas-
semic patients and to get the profile of ALT among thalassemic
patients who have increased TS and positive anti-HCV.
Methods This cross-sectional descriptive study was conducted
on β- and β-HbE-thalassemic patients at the Thalassemia Outpa-
tient Clinic, Department of Child Health, Medical School, Univer-
sity of Indonesia–Cipto Mangunkusumo Hospital in May 2002.
Results Subjects were 57 homozygous β-thalassemic and 33 β-
HbE-thalassemic patients. No one had regular desferoxamine or
history of splenectomy. Proportions of increased ALT, TS, and posi-
tive anti-HCV were 76%, 78%, and 6%, respectively. Duration of
illness, total volume of packed red cell (PRC) transfusions, TS level,
and positive anti-HCV seemed to have role in the increased pro-
portion of subjects with increased ALT, whereas duration of illness
and total volume of PRC seemed to have role in the increased TS.
Conclusion Factors that seem to have a role in the increased
proportion of subjects who had increased ALT and TS were (1)
duration of illness, total volume of PRC transfusion, TS, and posi-
tive anti-HCV; 2) duration of illness and total volume of PRC trans-
fusion, respectively
References
Wahidiyat I, Gatot D, Mangunatmadja I, editors.
Perkembangan mutakhir penyakit hematologi onkologi
anak. PKB IKA XXIV FKUI 1991. Jakarta: Bagian IKA
FKUI; 1991. p. 109-12.
2. Hematology subdivision. Petunjuk diagnosis dan
tatalaksana kasus thalassemia. Jakarta: Bagian IKA
FKUI/RSCM; 1997. p. 1-20.
3. Weatherall DJ, Clegg JB. The b thalassemias. In: The
thalassemia syndromes. 3 rd ed. Oxford: Blackwell Sci-
entific Publications; 1981. p. 148-631.
4. Wirawan R, Lembar S. Hemokromatosis: klasifikasi,
diagnosis dan penatalaksanaan. Maj Kedok Indon
2000;50:296-303.
5. Modell CB. Management of thalassaemia major. Br
Med Bull 1976;32:270-6.
6. Bacon BR, Brown KE. Iron metabolism and disorders of
iron overload. In: Kaplowitz N, editor. Biliary diseases.
2 nd ed. Baltimore: Williams & Wilkins; 1996. p. 349-62.
7. Bonkovsky HL, Ponka P, Bacon BR. An update on iron
metabolism: summary of the fifth international con-
ference on disorders of iron metabolism. Hepatology
1996;24:718-29.
8. Sharma BK, Bacon BR, Britton RS, Park CH, Magiera
CJ, O’Neill R, et al. Prevention on hepatocyte injury
and lipid peroxidation by iron chelators and a-tocopherol
in isolated iron-loaded rat hepatocytes. Hepatology
1990;12:31-9.
9. Zulkarnain Z. Tinjauan multi aspek hepatitis virus C
pada anak. In: Zulkarnain Z, Bisanto J, Pujiarto PS,
Oswari H, editors. Tinjauan komprehensif hepatitis vi-
rus pada anak. PKB IKA XLIII FKUI. Jakarta: Balai
Penerbit FKUI; 2000. p. 57-72.
10. Bonkovsky HL, Banner BF, Rothman AL. Iron and
chronic viral hepatitis. Hepatology 1997;25:759-68.
11. Bassett SE, Di Bisceglie AM, Bacon BR, Sharp RM,
Govindarajan S, Hubbard GB, et al. Effects of iron load-
ing on pathogenicity in hepatitis C virus-infected chim-
panzees. Hepatology 1999;29:1884-92.
12. Desforges JF. Screening for hemochromatosis. N Engl
J Med 1993;328:1616-20.
13. Powell LW, George K, McDonnell SM, Kowdley KV.
Diagnosis for hemochromatosis. Ann Intern Med
1998;129:925-31.
14. Pratt DS, Kaplan MM. Evaluation of abnormal liver-
enzyme results in asymptomatic patients. N Engl J Med
2000; 342:1266-71.
15. Gruen JR, Goei VL, Capossela A, Chu TW. Hemochro-
matosis in children. In: Suchy FJ, editor. Liver disease in
children. 1 st ed. St. Louis: Mosby; 1994. p. 773-80.
16. Kaplan MM. Laboratory tests. In: Schiff L, Schiff ER,
editors. Diseases of the liver. 7 th ed. Philadelphia: JB
Lippincott Company; 1993. p. 108-44.
17. Maller ES. Laboratory assessment of liver function and
injury in children. In: Suchy FJ, editor. Liver disease in
children. 1 st ed. St. Louis: Mosby; 1994. p. 269-93.
18. Kelly DA. Useful investigations in the assessment of liver
disease. In: Diseases of the liver and biliary system in
children. Oxford: Blackwell Science Ltd; 1999. p. 3-8.
19. Jaiswal SPB, Chitnis DS, Jain AK, Inamdar S, Porwal
A, Jain SC. Prevalence of hepatitis viruses among multi-
transfused hemogenous thalassemia patients. Hepatol
Research 2001;19:247-53.
20. Okada S, Taketa K, Ishikawa T, Koji T, Swe T, Win N, et
al. High prevalence of hepatitis C in patients with thalas-
semia and patients with liver diseases in Myanmar (Bur-
man) [abstract]. Acta Med Okayama 2000;54:137-8.
21. Roesli T. Hubungan peningkatan saturasi
transferin, infeksi virus hepatitis B dan C dengan
gangguan fungsi hati pada penderita thalassemia
beta mayor [thesis]. Jakarta: Department of Clini-
cal Pathology, Medical School, University of Indo-
nesia; 2001.
22. Wonke B, Hoffbrand AV, Braun D, Ducheiko G. Anti-
body to hepatitis C virus in multiply transfused patients
with thalassaemia major. J Clin Pathol 1990;43:638-40.
23. Lau YL. Hepatitis C virus antibody in multiply trans-
fused Chinese with thalassaemia major [abstract]. Bone
Marrow Transplant 1993;12 (Suppl 1):26-8.
24. Saberi-Firoozi M, Yazdankhah S, Karbasi HT. Anti-
HCV seropositivity among multiply transfused patients
with b-thalassaemia major in Southern Iran. Iran J Med
Sci 1996;21:59-60.
25. Al-Fawaz T, Remia S. Decline in hepatitis B infection
in sickle cell anaemia and b thalassaemia major. Arch
Dis Child 1993;69:594-6.
26. Vullo R, Modell B, Georganda E. Question about iron
overload and desferal. In: What is thalassaemia? 3 rd
ed. Nicosia: Thalassaemia International Federation;
1995. p. 26-8.
27. Li CK, Chik KW, Lam CWK, To KF, Yu SCH, Lee V.
Liver disease in transfusion dependent thalassaemia
major. Arch Dis Child 2002;86:344-7.
28. Bhatti FA, Amin M, Saleem M. Prevalence of anti-
body to hepatitis C virus in Pakistani thalassaemics by
practice agglutination test utility C 200 and C 22-3
viral antigen coated particles. J Pak Med Assoc
1995;45:269-71.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2016-09-29
Published 2016-10-10