Transfusions / sickle cell / hepatitis

What are the odds?
There may be more to transfusion than simply the transferring of hepatitis? ..
hepatitis = elevated iron or elevated iron = hepatitis?

<<snip>>
None of the 12 patients who never received transfusion were positive for HCV
antibody
<<snip>>

J Natl Med Assoc. 2003 Oct;95(10):939-42.  Related Articles, Links  


Hepatitis C virus in sickle cell disease.

Hassan M, Hasan S, Giday S, Alamgir L, Banks A, Frederick W, Smoot D, Castro O.

Division of Gastroenterology, Howard University Hospital, Washington, DC, USA.

PURPOSE: To determine the prevalence of hepatitis C virus antibodies (anti-HCV)
in patients with sickle cell disease. PATIENTS AND METHODS: Between 1983 and
2001, 150 patients from the Howard University Hospital Center for Sickle Cell
Disease were screened for HCV antibody (52% women, 48% men, mean age 34 years).
Frozen serum samples from 56 adult sickle cell patients who had participated in
previous surveys (1983-92) of HIV and HTLV-1 serology and who were tested in
1992 for anti-HCV antibody--when commercial ELISA test (Ortho) became
available--were included in this paper. Of the 150 patients in the study, 132
had sickle cell anemia genotype (SS), 15 had sickle cell hemoglobin-C disease
(SC) and three had sickle beta thalassemia. Clinical charts were reviewed for
history of blood transfusion, IV drug abuse, homosexuality, tattooing, iron
overload, and alcohol abuse. RESULTS: Antibodies to HCV were detected in 53
patients (35.3%). Of the 55 patients who had frozen serum samples tested in
1992, 32 (58%) were reactive for anti-HCV, while only 21 of the 95 patients
(22%) tested after 1992 were positive for HCV antibodies (P<0.001). Thirty-nine
of 77 patients (51%) who received more than 10 units of packed red blood cells
were positive for HCV antibody, and only 14 of 61 patients (23%) who received
less than 10 units of packed red blood cells transfusion were positive for HCV
antibodies (P<0.001). None of the 12 patients who never received transfusion
were positive for HCV antibody. In the 53 anti-HCV positive patients, the mean
alanine amino-transferase (ALT) value was 98- and 81 U/L, respectively, for
males and females. These values were normal for the HCV-antibody negative
patients. The aspartate amino-transferase (AST) and the total bilirubin were
also higher in the anti-HCV positive patients compared to patients in the
anti-HCV negative group. Forty-four patients (57.1%) who were transfused more
than 10 units developed iron overload defined by a serum ferritin level higher
than 1,000 ng/ml. A total of 20 of the patients with iron overload underwent
liver biopsies. Seven of these 20 patients (35%) were HCV positive. These
patients often had more severe liver disease and higher degree of iron
deposition. CONCLUSION: The prevalence of HCV antibody and iron overload is
directly related to the number of blood transfusions in patients with sickle
cell disease. The prevalence of HCV infection has decreased significantly,
since blood donor screening for HCV became available. Chronic HCV infection and
iron overload place sickle cell patients at risk for significant liver disease.

PMID: 14620705 [PubMed - in process] 

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