[Hepatitis associated aplastic anemia in relation to liver cell injury]

Background: Aplastic anemia [AA] is a disorder characterized by pancytopenia and injury or loss of pluripotent hematopoietic stem cells in the absence of infiltrative disease of the bone marrow. Hepatitis-associated aplastic anemia [HAAA] is a variant of AA

Aim of the study: To investigate the possible etiology responsible for the development of HAAA

Patients and methods: 42 patients were admitted to Assiut university hospital diagnosed as having AA. Data from history, physical examination and laboratory investigations, including complete blood count [CBC], viral serology and liver function tests were collected and statistically analyzed

Results: Patients were divided into group A [HAAA, 9 patients] 7 of them had hepatitis C virus, one with hepatitis A virus and one with cvtomegalovirus and group B [non-HAAA, 33 patients]. There was no significant difference as regard to CBC between HAAA patients and non-HAAA patients. There were significant negative correlations between alanine transaminase [ALT] and CBC findings in patients with HAAA

Conclusion: HAAA is caused by variable hepatotropic and non-hepatotropic viruses. The pathogenesis of hepatitis associated aplastic anemia HAAA may be attributed to liver cell injury, disturbed liver functions and its effects on hematopoiesis

Lymphocyte subsets and cytokines in ascitic fluid of decompensated cirrhotic patients with and without spontaneous ascites infection

Background: Spontaneous bacterial peritonitis [SBP] is a frequently encountered and important complication of decompensated liver cirrhosis. The immune system plays an important role in the development or eradication of this infection. A number of compositional and functional alterations in immune system cells have been demonstrated in cirrhotic patients: however, there is a lack of knowledge about this issue in ascitic infections

Aim of the study: The aim of the present study was to evaluate lymphocyte subsets and levels of some ascitic and lymphocytic intracytoplasmic cytokines in decompensated cirrhotic patients with or without spontaneous bacterial peritonitis which may help to understand the role of immune system in pathogenesis of SBP and consequently introduction of new therapeutic modalities

Subjects and methods: This case-control study included 50 decompensated cirrhotic patients [37 male. 13 female] from gastroenterology and hepatology unit of internal medicine department; Assiut university hospital with different etiologies. Patients with ascitic polymorphonuclear leukocyte count >/=250/mm[3] and/or positive ascitic bacterial cultures were classified as the 'patients group' [n=25, mean +/- SD of age was 57.84 +/- 6.66 years]. Patients with ascitic poly morphonuclear leukocyte count <250/mm[3] and/or negative ascitic bacterial cultures were classified as the controls group [n=25, mean +/- SD of age was 60.36 +/- 6.51years]. Comparison was made between the patients and controls groups for the following parameters: ascites leukocyte counts and differentiations; ascitic fluid protein; albumin levels and serum-ascites albumin gradients; flow cytometric detection of ascitic lymphocyte subsets [CD3, CD4. CD8, CD4/CD8 ratio. CD19, CD45] and ascitic cytokine TNF-alpha

Results: Ascitic total protein and albumin levels were significantly decreased in patients group. The C4, CD19. CD45 and CD4/CD8 ratio were significantly decreased in the patients group. Furthermore, ascites CD3, CD8 and TNF-alpha levels were significantly elevated in this group. The incidence of renal impairment, gastrointestinal bleeding and hepatic encephalopathy was higher in patients group and there was a significant correlation between TNF-alpha and renal impairment in this group

Conclusion: These results suggest that a cytotoxic, especially Th1, immune response predominates in ascites infections. It also demonstrates that TNF-alpha might he involved in the pathogenesis of ascites infections