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Chronic liver dysfunction in multitransfused hemophiliacs

U W Hasiba, J A Spero, J H Lewis

    Transfusion
    |September 1, 1977
    PubMed
    Summary

    Patients with hemophilia (factor VIII or IX deficiency) receiving blood products showed varying liver dysfunction. Cryoprecipitate therapy was associated with the lowest incidence of abnormal liver enzymes, suggesting a safer treatment option.

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    Area of Science:

    • Hepatology
    • Hematology
    • Immunology

    Background:

    • Patients with factor VIII or IX deficiency are at risk of liver dysfunction due to blood product exposure.
    • Hepatitis B virus (HBV) infection is a concern in hemophilia patients receiving transfusions.

    Purpose of the Study:

    • To assess liver dysfunction (serum transaminase levels) and hepatitis B virus (HBV) exposure (HBsAg, anti-HBs) in patients with factor VIII or IX deficiency.
    • To evaluate the relationship between different therapeutic modalities and liver enzyme abnormalities.
    • To determine the protective effect of anti-HBs antibodies against jaundice.

    Main Methods:

    • Prospective study over three years in 118 patients with factor VIII or IX deficiency.
    • Monitoring of serum transaminase (SGPT, SGOT), HBsAg, and anti-HBs levels.
    • Patients categorized based on therapy: factor VIII concentrates (large/small exposure), prothrombin complexes, and cryoprecipitate.

    Main Results:

    • Persistently abnormal transaminases were observed in 51% (large factor VIII exposure), 43% (small factor VIII exposure), and 37% (prothrombin complexes).
    • Only 8% of patients treated solely with cryoprecipitate showed abnormal transaminases.
    • Patients with persistent hepatitis B antigenemia had significantly higher transaminase levels.
    • Anti-HBs antibodies were present in patients treated with pooled plasma products without persistent antigenemia.
    • High anti-HBs titer before therapy appeared protective against jaundice.

    Conclusions:

    • Therapy with factor VIII concentrates and prothrombin complexes is associated with a higher risk of liver dysfunction compared to cryoprecipitate.
    • Cryoprecipitate therapy demonstrates a lower incidence of serum transaminase abnormalities in hemophilia patients.
    • Presence of anti-HBs antibodies may confer protection against HBV-related jaundice in this patient group.

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