ABSTRACT
OBJECTIVE: To confirm the existing evidence that blood letting reduces serum aminotransferase levels and to seek factors associated with a greater reduction in subjects with chronic hepatitis C and iron overload. DESIGN: Prospective, open label, non controlled study in two northern Italian hospitals. PATIENTS: Sixteen patients with histologically proven chronic hepatitis, positive hepatitis C virus serology, HCV-RNA detectable in their sera, and histological and biochemical signs of iron overload, nonresponders to interferon alpha therapy, underwent weekly phlebotomies until serum ferritin values < or = 50 ng/mL were obtained. Serum aminotransferases, serum ferritin and transferrin saturation were then measured and compared with values at baseline. RESULTS: Alanine aminotransferase and aspartate aminotransferase levels fell after phlebotomies from 193 +/- 107 IU/L to 115 +/- 53 IU/L (t = 4.94, p = 0.0001) and from 124 +/- 60 IU/L to 85 +/- 35 IU/L (t = 3.76, p = 0.002), respectively. The magnitude of the reduction correlated with baseline aminotransferase levels (r = 0.68, p = 0.004 for alanine aminotransferase and r = 0.63, p = 0.009 for aspartate aminotransferase), but not with those of serum ferritin and transferrin saturation percentage, nor with the quantity of iron removed. There was a trend towards a greater alanine aminotransferase reduction in patients with the highest baseline serum ferritin (r = 0.26, p = 0.14). CONCLUSIONS: Blood letting was effective in reducing serum aminotransferase levels of patients with chronic hepatitis C and iron overload, especially those with the highest baseline aminotransferase levels.
