ABSTRACT
Multitransfused beta-thalassemia patients constitute a population with high prevalence of Hepatitis C virus [HCV] infection, because of transmission of HCV from infected blood donors. Increased hepatic iron is assumed to potentiate progression towards liver fibrosis in chronic HCV infection. The aim of the present work is to evaluate the potentiating effect of marked hepatic iron overload and chronic HCV infection on hepatic fibrosis in Thalassemia patients. Sixty eight patients, previously diagnosed to have homozygous beta-thalassemia and followed up at the Hematology Clinic of the New Children's Hospital of Cairo University [44 hepatitis C positive and 24 hepatitis C negative patients], were selected to participate in this study after signing a written informed consent. Their age ranged between 6 and 27 years with a mean age of 9.7 +/- 2.1 years and compared to a group of 42 non thalassemic chronic HCV patients whose age ranged between 7 and 27 years with a mean age of 10.9 +/- 1.5 years [control group]. Liver Biopsies were done for all patients for estimation of stage of hepatic fibrosis and liver iron content [LIC]. The results were then correlated to liver function tests and serum ferritin. The stage of fibrosis and LIC were significantly higher in beta-thalassemia patients than the non thalassemia HCV patients [p = 0.005, p<0.0001 respectively]. There was no significant difference between the two groups of thalassemia as regards staging of fibrosis. The degree of hepatic fibrosis was significantly correlated to the LIC in hepatitis negative thalassemic group while it was significantly correlated to serum ferritin in thalasemic patients with positive HCV. Hepatic iron overload has a potentiating effect on hepatic fibrogenesis in beta-thalassemia major. The proper use of chelating agents is of great importance in delaying progression of liver disease in these patients