الفهرس 
Hepatitis C VirusOnly 14 pages are availabe for public view
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Abstract
nfection with hepatitis C virus (HCV) can lead to several extrahepatic manifestations (EHM). Hematologic diseases such as cryoglobulinemia and lymphoma, autoimmune disorders such as thyroiditis, renal diseases, dermatologic conditions such as lichen planus and porphyria cutaneatarda, Lymphoproliferative disorders.
Cryoglobulinaemia is among the most common and closely linked extrahepatic HCV manifestations and is most often a mixed cryoglobulinaemia of type 2 or 3. Considered a lymphoproliferative disorder, it is thought to result from chronic stimulation and over production of B cells producing immunoglobulin.
We aimed to study the frequency of occurrence of mixed cryoglobulinemia (MC) manifestations among hepatitis C virus infected children attending the Pediatric Hematology Oncology Unit, Ain Shams University, to assess its relation to the level of hepatitis C viremia and to compare its frequency among hepatitis C virus beta thalassemia and childhood cancer survivors patients.
This cross sectional study included 50 Hepatitis C virus infected patients; 25 Beta thalassemia patients and 25 childhood cancer survivors patients; recruited form the haematology/oncology clinic Children’s hospital Ain Shams University.
Methods: Data was gathered from medical records of the patients and from patients and/or legal guardians including:
History with special emphasis on: Age of onset,type of cancer and duration,transfusion history, mean serum ferritin, history of splenectomy and time of the procedure, calculation of Aspartate amino transferase Platelets Ratio index (APRI score), hepatits C virus infection history, history of drug therapy for hepatitis C infection and chelation therapy, history of extrahepatic manifestations of HCV infection.
Thorough clinical examination laying stress on weight and height, sexual maturity rating and complete examination of all systems.
Laboratory investigations (Qualitative cryoglobulin assessment, liver function tests (ALT, AST), Kidney function tests: (BUN) Blood urea nitrogen, (Urea), serum creatinine, serum albumin level and HCV RNA by PCR.
Group 1: Beta thalassemia major (25 patients), they were 10 males (40.0%) and 15 females (60.0%) (Male to female ratio was 2: 3). Their age at evaluation ranged between 3 – 19 years with a mean (13.60 years 4.00)
Group 2, Cancer survivor group (25 patients) they were twenty males (80 %) and five females (20 %).Their age at evaluation ranged from 6 – 19 years with a mean( 10.56 years 3.10). Their age at diagnosis ranged between 3 to 10 years. Fifteen patients (60.0%) had acute lymphoblastic leukemia (ALL), Five (20.0 %) had NH lymphoma, two (8.0%) Hodgkin Lymphoma, two (8.0%) neuroblastoma and one (4.0%) retinoblastoma patient.
All childhood cancer survivor patients and Beta thalassemia major patients had negative cryoglobulinemia.
Acute lymphoblastic leukemia was the most common malignancy among childhood cancer survivor patients. Thirty two percent of childhood cancer survivor patients had extra-hepatic manifestations. (16 %) had arthralgia, (8 %) had renal affection, (4 %) CNS, chest affection; none had vasculitis nor heart affection. Childhood cancer survivor patients with elevated transaminases had significantly higher mean serum ferritin than those without, yet both had comparable APRI score and HCV RNA copies. There was a significant positive correlation between APRI score and serum transaminases levels (AST and ALT) among childhood cancer survivor patients. There was a significant positive correlation between, mean serum ferritin and number of transfusions and transfusion index among childhood cancer survivor patients. There was no significant correlation between APRI score and mean serum ferritin, transfusion index and number of transfusions among childhood cancer survivor patients. There was no significant correlation between APRI score and HCV-RNA PCR copies among childhood cancer survivor patients.
Twenty four percent of beta thalassemia patients had extra-hepatic manifestations. (18 %) had arthralgia, (8%) had renal manifestations; none had vasculitits, chest, heart nor CNS affection. Patients with elevated liver function tests and those without had comparable APRI score. There was positive correlation between APRI score and serum transaminases levels (AST and ALT), however there was no significant correlation between APRI score and serum albumin and kidney function tests (BUN, serum creatinine) among beta thalassemia patients. There was significant positive correlation between mean serum ferritin and serum transaminases levels (AST and ALT) but we did not find significant correlation between mean serum ferritin and serum albumin and kidney function tests (BUN, serum creatinine) among beta thalassemia patients.
Beta thalassemia patients had a significant higher transfusion index compared to childhood cancer survivor patients. Frequency of hepatic manifestations was significantly higher among beta thalassemia patients compared to childhood cancer survivors. Beta thalassemia patients had significantly higher mean serum ferritin compared to childhood cancer survivor patients. No significant difference between both groups as regard APRIscore, liver transaminases and HCV-RNA PCR copies. There was no significant difference between beta thalassemia and childhood cancer survivor patients as regard percentage of patients with elevated transaminases (1.5 – 3× UNL).