THE PREVALENCE OF HEPATITIS C VIRUS INFECTION AND POTENTIAL RISK FACTORS AMONG MULTIPLY TRANSFUSED PATIENTS

Objective: Patients who frequently receive blood have high risk of hepatitis C virus (HCV) infection. This study aimed to evaluate the prevalence of HCV infection and potential risk factors among multiply transfused patients.Methods: A cross-sectional retrospective study was conducted in the hemophilia unit in Medical City in Baghdad, between June 1, 2016, and January 1, 2017. After taking consents and approval of ethical comity, the medical records of 1158 patients with hemophilia A and B, von Willebrand disease (vWD), thrombasthenia, Factors VII, X, and XIII deficiencies, and hypofibrinogenemia were analyzed for the presence of HCV antibody using (enzyme-linked immunosorbent assay). Cases of hemophilia were classified into mild, moderate, and severe.Results: The prevalence of HCV infection was 13.2%. Of total, 595 (51.4%) patients had hemophilia A and 99 (16.6%) were anti-HCV positive, while 225 (19.4%) had hemophilia B and 28 (12.4%) were antibody positive compared to 9 (7%) in vWD. Of those with hemophilia A, 515 (86.6%) had severe hemophilia, and 32 (32.32%) cases had acquired HCV infection after 1996 (after introduction of HCV screening in blood banks in Iraq). There was a statistically significant association with treatment by Factor VIII only.Conclusion: The prevalence of HCV in patients with inherited bleeding disorder is 13.2%. In this study, it was found that multitransfusion is the only predictor for HCV infection in this group of patients.Â

The Epidemiological Characteristics of Hepatitis C Virus Among Patients with Inherited Bleeding Disorders

Background: Patients who frequently receive blood and or blood products have high risk of hepatitis C virus (HCV) infection.Objectives: To evaluate the prevalence of (HCV) infection and determine potential risk factors among patients with inherited bleeding disorders.Patients and Methods: Across sectional retrospective study was conducted in the Hemophilia unit in Children Welfare Teaching Hospital, Medical city in Baghdad; between 1st of Juneof2014 to 1stof January of 2015. The medical records of 1158 patients with hemophilia A& B, von Willebrand disease (vWD), thrombosthenia, factors VII, X, XIII deficiencies and hypofibrinogenemia; of all ages were analyzed for the presence of HCV antibody using (ELISA) and for HBs antigen as co-infection.Results: The overall prevalence of HCV infection was (13.2%). Of total, 595 (51.4%) patients had hemophilia A and 99 (16.6%) were anti-HCV positive, while 225 (19.4%) had hemophilia B and 28 (12.4%) were antibody positive compared to 9 (7%) in vWD. Co infection of HBV was only found in hemophilia A with a prevalence of0.5%.Of those with hemophilia A, 515 (86.6%) had severe hemophilia. Thirty two(32.32%) cases of hemophilia A had acquired HCV infection after 1996 (after introduction of HCV screening in blood banks in Iraq) and there was a statistically significant association with treatment by factor VIII only. Conclusions: The prevalence of HCV in patients with inherited bleeding disorder is (13.2%). Since no independent risk factor was found in this high risk group, it can be concluded that multitransfusion is the only predictor for HCV infection. Anti-HCV antibody positivity was associated with the age at diagnosis of hemophilia, type of treatment and presence of inhibitory antibodies but not with the type of hemophilia, the severity of the disease nor positivity to HBV. Keywords: Hepatitis C virus, hemophilia, bleeding disorders

A Study of Thyroid Dysfunction in Patients with End Stage Renal Disease on Hemodialysis

Background: Progression of chronic kidney disease (CKD) is associated with having a number of complications, including thyroid dysfunction. CKD affects the thyroid function by lowering levels of circulating thyroid hormones, interfering with hormones binding to protein carriers, disrupting metabolism and elimination of thyroid hormones.Aim of the study: We aimed to evaluate and compare thyroid functions among patients on chronic hemodialysis (HD) and healthy participants. Methods: This is a cross- sectional study conducted in the dialysis unit of Baghdad teaching hospital from ( May 2015 to November 2015). A total of 45 known CKD cases (stage 5) older than 18 year were included in the study. Patients with known thyroid disorders, on medications affecting thyroid function were excluded from the study. All subjects were clinically euthyroid, they were investigated with laboratory tests to determine blood urea, serum creatinine, body mass index, estimated glomerular filtration rate (eGFR), thyroid function including: serum triiodothyronine (T3), thyroxin (T4), free T3, free T4, and thyroid- stimulating hormone (TSH).Results were compared with the same measurements in 20 normal subjects as a control group.Results: Of total sample of patients, 22(48.9%) were male, 23(51.1%) were female; with mean age of 50.96± 14.26 years. In control group; 12 (60%) were male, 8 (40%) were female with mean age of 40.25± 11.86 years. In HD group; we found statistically significant lower mean values of T3 (1.54± 0.67, p= 0.009), free T3 (2.65± 0.92, p <0.001), and higher frequency of low T3 syndrome in 73. 33% (n=33) vs. 5% (n= 1) with (p <0.001). Subclinical hypothyroidism was found in control group only, in  20% (n= 4), (p <0.001). There was a strong correlation between S. creatinine with free T3, correlation coefficient (- 0.378). In patients on HD for equal or more than a year; we found statistically significant lower mean values of T3 (1.07± 0.23) vs. (1.66± 0.69), (p= 0.016), in spite of significant increase in mean eGFR of (9.00± 4.82) vs. (6.39± 3.08), (p= 0.05). There was a statistically significant association between total T4 and presence of DM, (P=  0.044).Conclusions: We observed that functional thyroid gland disorders are more common among patients on chronic hemodialysis compared with healthy subjects, and reveal their link with time on dialysis. Low T3 syndrome (Euthyroid sick syndrome)is the most frequently thyroid function disorder. Keywords: Triiodothyronine, Hemodialysis, Low T3syndrome, Euthyroid sick syndrome