Chronic hepatitis C virus infection: prevalence of cryoglobulinemia and renal affection in the Egyptian patients

The association between mixed cryoglobulinema [MC], chronic hepatitis C virus [CHC], and renal insufficiency was documented. This paper aimed to determine the prevalence of cryoglobulinemia [CG], and renal affection drug-naive Egyptian patients suffering from CHC-in a cross-sectional study So, 53 patients with CHC and 20 healthy controls were included. Parameters investigated covered; HCV antibodies, HCV RNA, liver profile [AST, ALT, serum albumin, total bilirubin, prothrombin time], renal profile [urea, uric acid, creatinine clearance, urinary albumin], CG, C3, .C4, and three MDRD equations to calculate the GFR. The results showed that CG was found in all patients, but none in controls. The renal markers showed that none of the patients suffered frank nephropathy, but were at increased risk for developing kidney disease

Portal vein thrombosis and haematemesis in chronic liver disease. Are P-selectin and PSGL-1 clues?

Bleeding and thrombotic complications are common problems in patients with chronic liver disease [CLD]. The aim of the present study was to evaluate the level of soluble P [sP]-selectin, and P-selectin glycoprotein ligand-1 [PSGL-1] [CD162] expression on neutrophils among patients with CLD and to clarify the role of their interaction, by measuring the platelet leucocyte aggregates, on the clinical outcome of the haemostatic balance in those patients. We also investigated the hypothesis that the balance between platelet activation and endothelial biological function is impaired. sP-selectin and thrombomodulin [TM] levels were measured by enzyme-linked immunosorbent assay [ELISA] and flowcytometric detection of CD162 was performed. Platelet-leucocyte aggregation [PLA] in whole blood was measured as positive for CD41a and CD45 in 66 CLD patients divided into the portal vein thrombosis group [PVT] [n = 25], the haematemesis group [n = 21] and the haemostatically stable group [n = 20]. sP-selectin was significantly elevated in all patient groups. Decreased surface expression of CD162 on neutrophils was detected in all patients' groups. PLA was statistically significantly increased in the PVT group. TM was statistically significantly increased in the PVT, haematemesis and haemostatically stable groups. PLA may play a role in the unique PVT outcome of the haemostatic balance in a group of patients whose credentials of hyperdynamic portal circulation predispose them to bleeding rather than thrombosis. Consequently, P-selectin-targeted therapy may be used to prevent this complication

Impact of neutrophil apoptosis on haemostatic activation in chronic liver disease patients

Recent studies suggest the impact of apoptosis on the mechanisms leading to hypercoagulability. We aimed to clarify the potential role of neutrophil apoptosis in neutropenia and hypercoagulable state encountered in chronic liver disease patients. This study was conducted on fifteen normal controls and fourty five patients with chronic liver disease classified according to modified Child Pugh classification into, Child A, B and C groups [15 cases each]. Studied Haemostatic parameters include, prothrombin time, partial thromboplastin time, tissue factor, protein C antigen, protein S antigen, and markers of haemostatic activation [prothrombin fragment 1+2, thrombus precursor protein and D-dimer]. Flowcytometric study was done for quantitative assay of neutrophil apoptotic subpopulations to detect the percentage of early and late apoptotic, and necrotic neutrophils using AnnexinV-FITC/Propidium iodide dye. Semiquantitative assay of apoptotic neutrophils showing DNA fragmentation was performed on neutrophil culture using terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labeling [TUNEL] test. In addition to enzyme linked immunosorbent assay for soluble Fas [APO-1/CD95] in culture supernatant. The results revealed a rise in the neutrophil apoptotic and necrotic markers with progression of the disease, and they were inversely correlated with the absolute neutrophil count. The apoptotic neutrophil cells showed a significant positive correlation with several haemostatic parameters [tissue factor, prothrombin fragment 1+2, thrombus precursor protein and Ddimer], which further incriminate the apoptotic mechanisms in the hypercoagulable state encountered in this clinical setting. Enhanced neutrophil apoptosis and necrosis in patients with chronic liver disease may explain in part the mechanism of neutropenia in these patients and may be one of the important factors which drive the haemostatic balance towards the hypercoagulable state