الفهرس 
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Abstract
Hereditary hemolytic anemias include hemoglobin abnormalities,
erythrocyte membrane and enzymatic defects,: -Thalassemia -Sickle
cell anemia. -Hereditar spherocytosis. - Glucose - phosphate
dehydrogenase (G- -PD) deficiency.
Thalassemia is one of the most common genetic diseases in the
world. Though regular blood transfusion in patients with hereditary
hemolytic anemia, particularly thalassemia, has improved their overall
survival, but carries a definite risk of acquisition of blood-borne virus
infections, especially viral hepatitis. Nowadays, vaccination against
hepatitis B has efficiently been able to restrict the transmission of
hepatitis B virus (HBV) infection. However, post-transfusion
transmission of hepatitis C virus (HCV) has still remained a major health
concern in hereditary thalassemic patients.
This work aimed to estimate the prevalence of blood born hepatic
viruses including HCV, HBV and CMV in children with chronic
heriditary hemolytic anemia in (Menoufia and Zagazig Governorates).
Four hundred and seventy seven( ) hereditary hemolytic aneamia
patients ( thalassemia major, thalassemia intermedia , sickle
thalassemia and other types) ( cases spherocytosis, cases pyruvate
kinase deficiency and cases alpha thalassemia) were included in the
present study. Their ages ranged from to years with mean age = ±
years. Patients were selected from those attending the outpatient clinic
for regular follow-up and blood transfusion at the hematology unit of pediatrics of Monoufia University and at hematology clinic of the
Children’s Hospital, Zagazig University.
All patients were subjected to the followings;
Full history taking including the present and the past history of the
illness and full clinical examination.
- Laboratory investigations: routine and specific.
Laboratory investigations included:
Complete blood count (CBC): by using (Sysmex XN - SA-
,Germany )to estimate hemoglobin level and blood
indices.
Serum ferritin : by using (Cobas e ,) We calculated mean
ferritin through the following equation:
Mean ferritin=summation of annual ferritin values /number of
values.
Liver function tests: Using the Beckman coulter (synchron CX
ALX) clinical auto analyzer, USA.
Serum alanine aminotranferase (ALT).
Serum aspartate aminotransferase (AST) .
Total bilirubin (TB) .
Hepatitis markers.
Serology for HBV (HBsAg ).
Serology for HCV (HCVAb).
Serology for CMV (CMV IgM Polymerase chain reaction (PCR) for seropositive HCV to detect
HCV RNA.
As regard to our result:
Prevelance of HCV among Egyptian hemolytic children in
Menoufia and Zagazig: was % confirmed by PCR.
No cases of HBV were detected.
Prevelance of CMV among Egyptian hemolytic children in
Menoufia and Zagazig was .
The most prevelant chelation drug was Deferasirox ( ) then
Deferiprone ( ) followed by combination of Deferasirox &
Desferoxamin ( ). Desferoxamin percent was . There
was of all studied subjects had not receive any chelation.
The patient compliance was bad as only were compliant and
were uncompliant.
The range of pretransfusion hemoglobin was ( - ) and Mean ±
SD was ± . . The range of WBCs was ( - ) and Mean
± SD was ± . The range of mean Ferritin was (
) and Mean ± SD was ± .
The risk factors for hepatitis C virus :
)- Age of the patient as the incidence increase significantly with age
(P = ).
)- Blood transfusion duration (P = ) have significant effect on
the prevelance of HCV. It increase with increase blood transfusion
duration (p= ).
)- Transfusion frequency had significant impact on HCV positivity
while RBCs transfusion index had no significant effect.
)- There were significant difference according to HCV status
regarding ferritin (p= ).
)- HCV positive patients had significantly hiegher platelets, AST
(t= ) (p= ) and ALT (t= ) (p= ) compaired to HCV
negative patients.
The gained data from our study reveal that
The prevalence of HCV and CMV infection is high in patients
with Hereditary hemolytic anemias compared to HBV.
Vaccination against HBV, completely or partially, was
associated with less chances getting infection with HBV.
Transfusion and age are the most important risk factors for
HCV infection. As The older age, The more number of
transfusions were associated with increased chances of infection
with HCV virus.
Although iron chelation therapy has successfully improved we
reported high plasma ferritin level of all studied subjects.
So that, thalassemic children experience various problems if the
transfusion is inadequate but at the same time repeated blood transfusions
are associated with hazards like iron overload and risk of acquiring
transfusion-transmitted infections (TTIs). All of that cause liver injury
with its complication. So all thalassemic children will need more proper
control of iron overload. Beside that we need to revise transfusion
system. We should use more sensitive screening marker for HCV like
PCR in blood bank to detect the virus in the window phase and reduce
the hazard of TTIs.