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Hepatitis C infection in children with hemophilia A and B
V S Blanchette1, E Vorstman, A Shore
1Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Hepatitis C virus (HCV) transmission is high in hemophilic children treated with unheated clotting factors. Vapor-heated concentrates significantly reduce HCV risk, offering safer treatment options for hemophiliacs.
Area of Science:
- Virology
- Hematology
- Public Health
Background:
- Hepatitis C virus (HCV) poses a significant health risk.
- Hemophilic children are vulnerable to bloodborne infections due to frequent transfusions.
Purpose of the Study:
- To quantitate antibodies to hepatitis C virus (anti-HCV) in hemophilic children.
- To assess the risk of HCV transmission associated with different clotting factor concentrate treatments.
Main Methods:
- Sera from hemophilic children (≤18 years) were analyzed for anti-HCV.
- Alanine aminotransferase (ALT) levels were measured to assess liver health.
- Treatment groups included: untransfused, vapor-heated concentrates, cryoprecipitate/single donor products, and unheated/dry heat-treated concentrates.
Main Results:
- Seropositivity rates for anti-HCV were 0% in untransfused, vapor-heated concentrate, and cryoprecipitate/single donor groups.
- 95% of hemophiliacs treated with unheated/dry heat-treated concentrates were anti-HCV positive.
- Elevated ALT levels (>40 U/L) were observed in 82% of those receiving unheated/dry heat-treated concentrates.
Conclusions:
- HCV is a primary cause of chronic hepatitis in multitransfused hemophilic children.
- Unheated and dry heat-treated clotting factor concentrates carry a high risk of HCV transmission.
- Vapor-heated clotting factor concentrates demonstrate a very low risk of HCV transmission, indicating therapeutic significance.
Abstract:
Antibodies to hepatitis C virus (anti-HCV) were quantitated in stored sera from selected groups of hemophilic children (less than or equal to 18 years of age). During the period 1987 to 1989, seropositivity rates were as follows: untransfused hemophiliacs 0% (0 of 11 cases), hemophiliacs treated exclusively with vapor-heated factor VIII or IX concentrates 0% (0 of 9 cases), hemophiliacs treated only with cryoprecipitate or single donor blood products 0% (0 of 9 cases), and hemophiliacs regularly treated with unheated or dry heat-treated factor VIII or IX concentrates 95% (21 of 22 cases). Corresponding alanine aminotransferase (ALT) results were similar: values were always below the upper limit of laboratory normal (40 U/L) in untransfused hemophiliacs, hemophiliacs treated with vapor-heated factor concentrates, or those who received only cryoprecipitate or single donor blood products. By contrast ALT values were greater than 40 U/L in 82% (18 of 22 cases) of hemophilic children regularly infused with unheated or dry heat-treated factor concentrates. Three conclusions are drawn from this data: (1) HCV is a major cause of chronic hepatitis in multitransfused hemophilic children, (2) unheated and dry heat-treated clotting factor concentrates carry a very high risk of transmitting HCV infection, and (3) clotting factor concentrates inactivated by vapor heating carry a very low and perhaps zero risk of transmitting HCV infection. These findings are of therapeutic significance for previously untransfused hemophiliacs susceptible to HCV infection.