Hepatitis b virus, hepatitis a virus and persistently elevated aminotransferases in hemophiliacs

Abstract

To determine the exposure to hepatitis A and hepatitis B viruses (HAV, HBV) following intravenous replacement therapy in patients with classic hemophilia and to assess the role of these viruses in persistently elevated aminotransferases, sera were studied from 136 patients from 9 months to 67 years of age were transfused with either single-donor cryoprecipitate (CRYO) or Antihemophilic Factor Concentrate (AHF) for periods ranging from a few months to 15 years. Serologic evidence of past or present infection with HBV was detected in 90% of all 136 patients and in 85% of those 34 patients 10 years of age or younger. Sixty-four percent of those with serologic markers of hepatitis B had high titers of antibody to the hepatitis B surface antigen and low titers of antibody to the hepatitis B core antigen. These findings are consistent with the known high frequency of early exposure to HBV in hemophiliacs receiving replacement therapy and with recovery from these hepatitis B infections. Sixteen percent of these patients had persistently elevated aminotransferase levels; HBV could not be implicated as the cause of the enzyme elevations in most of these cases.

Is the Use of the Term ‘Posttransfusion Hepatitis Type B’ in Its Conventional Sense Still Justifiable?

“…However, regarding 2 patients who had been given clotting factors in addition to blood transfusions, these blood derivatives have to be considered possible sources of infection. Such preparations that are pro duced from large plasma pools do indeed bear a considerable risk of infection, despite screening of donors for HBsAg [14,23,30,34], With respect to the remaining 5 patients, especially in consideration of the compre hensive investigations of our study, there is no reason whatsoever to assume causal con nection between blood transfusion and hep atitis that was reported subsequently. There fore, in these cases, it is not correct to use the term 'posttransfusion hepatitis' that implies transfused blood to be the source of infec tion.…”

Effects of HIV infection on age and cause of death for persons with hemophilia A in the United States

“…Most recipients of non-heat-treated plasma-derived factor concentrates have been infected with HBV [50] and HCV [40,51]. At least 50% of those infected with HCV get chronic hepatitis, and many eventually get cirrhosis [52].…”

Serum Enzymes and Enzyme Profiles in the Diagnosis of Liver and Biliary Tract Disease

“…143]. Due to their high usage of blood products, hemophiliacs are especially at risk, and 90% have serological evidence of exposure to hep atitis B virus [144], In a study of 1,332 hemo philiacs [145], 72% showed at least one ab normal value for AST over a 6-month peri od, and 16-20% lacking evidence of hepatitis B virus infection had persistently elevated levels. Because of the limited supply of donor blood.…”