Markers of HBV, HCV and HDV among multitransfused children

In order to study the profile of distribution of hepatitis B virus [HBV], hepatitis C virus [HCV], and hepatitis Delta virus [HDV] markers among multitransfused children, this study was carried out on 94 polytransfused cases [84 males and 10 females, their ages ranged from 2 to 13 years], as well as 25 apparently healthy children with matchable age and sex as controls. The studied cases included 51 patients with malignant disease [38 with acute leukemia and 13 with lymphoma], 33 with thalassemia major, and 10 hemophiliaes. All cases and controls were screened for the following HBV markers: hepatitis B surface antigen [HBsAg] antibodies to hepatitis B core antigen [Anti-HBc] and antibodies to hepatitis B surface antigen [Anti-HBs], as well as for antibodies to HCV [Anti-HCV]. Fifty cases were randomly studied for antibodies to HDV [Anti-HDV]. Serum levels of alanine amino-transferase [ALT] were evaluated in all the patients and controls. All cases and controls were subjected to study of human immunodeficiency virus [HIV] with negative results. Among the polytransfused cases, 45.74% were positive for one or more of the studied HBV markers while 27.66% were positive for Anti-HCV. As regards the controls, only one of them [4%] showed HBsAg while none of them was positive for Anti-HCV. The prevalence rate of one or more of HBV markers was significantly higher than that of Anti-HCV [p<0.01]. Also, the prevalence of both HBV and HCV markers increased significantly with the increase in frequency of blood transfusion. In relation to the underlying disease, both thalassemic patients and hemophiliacs showed significantly higher prevalence rates than cases with malignant disease regarding either one or more of HBV markers [p<0.001 and p<0.05 respectively] and regarding Anti-HCV [p<0.02 and p< 0.01 respectively]. Hepatitis B surface antigen and Anti-HBc were significantly more common in patients seropositive for Anti-HCV than in those without Anti-HCV [p < 0.05 for each]. Out of the 50 polytransfused cases screened for Anti-HDV, 6 cases showed this marker [12%], all of them exposed to blood transfusion for more than 5 times. Non of them was positive for Anti-HCV. The prevalence of Anti-HBc among cases positive for Anti-HDV was significantly higher than that among cases without Anti-HDV [p<0.05]. Serum levels of ALT were significantly higher among cases than controls irrespective of the presence or absence of HBV or HCV markers [p< 0.001]. Cases positive for markers of HBV or HCV or both showed significantly higher serum ALT levels than cases negative for these markers [p<0.05, p< 0.005, and p< 0.001 respectively]. In relation to the underlying disease, cases with either malignant disease or thalassemia showed significantly higher serum levels of ALT than hemophiliacs [p < 0.005 and p< 0.05 respectively]. However, all the 3 disease groups showed significantly higher serum ALT levels than controls [p< 0.001 for each]. Finally serum ALT exhibit significant elevation among cases simultaneously positive for both HBV and HDV markers than among those positive for HBV markers only [p < 0.05]. We concluded that because of the presence of cases showing Anti-HBc without HBsAg, screening of blood donors for Anti-HBc and HBsAg is desirable to decrease the incidence of hepatitis B viral infection among the poly transfused patients. Moreover, to decrease the incidence of hepatitis C viral infection, blood donors should be also screened for Anti-HCV combined with measurement of serum ALT until more than one marker for HCV is available, as the time of appearance of Anti-HCV is variable. In addition, we recommend early vaccination of children at risk of repeated blood transfusion against HBV to protect them from both HBV and HD V infections. Owing to the presence of cases showing Anti-HDV with HBV markers other than HBsAg, accurate estimation of the incidence and prevalence rates of HDV infection needs screening for Anti-HDV whether HBsAg is present or not