This study examined the frequency of Hepatitis B and Hepatitis C in 130 thalassemia major patients receiving regular blood transfusions at a hospital in Lahore, Pakistan. The results found that 8 patients (6.2%) were positive for Hepatitis B and 27 patients (20.8%) were positive for Hepatitis C, while 95 patients (73%) tested negative. Patients who received more than 20 blood transfusions had a higher rate of infection than those receiving fewer transfusions. The prevalence of Hepatitis C in this study was higher than found in other regional studies, possibly due to Pakistan starting screening for Hepatitis C later than Hepatitis B. Improving donor screening, patient education, and vaccination programs were recommended.

2.  Frequency of Hepatitis B and Hepatitis C
Virus Infection in Multi-Transfused
Thalassemia Major Patients

3. Authors
USMAN RASHID, ASIF IBRAHIM, FAISAL ZAFAR, Attia
Bari
Source
Pak Pediatr J 2017; 41(4): 207-10

4. Place of Study
Department of Pediatrics,
children hospital Lahore.
Study design
cross sectional observational study

6. Autosomal recessive disorder
Complete absence of beta globin chain production
Leads to severe anemia
Require repeated or frequent blood transfusion
Repeated transfusions exposes them to HIV,HCV
and HBV infection beside Iron overload
Multi transfused patients have high prevalence of
blood borne infections

7. Chronic viral hepatitis is a major health problem in
pakistan
Hepatitis is transmissible disease resulting from
improper screening of blood
Thalassemia patients on regular blood transfusion
and at high risk of hep B and C,
If frequency of diseases is high we need to adopt
proper screening and preventive measures

8.  total cases of hep B and C in Pakistan = 12
million cases

9. Study : cross Sectional observational study
Location : peads dept. CHL
Duration :11 jan 2014 to 10 july 2014
Sample size : 130
Hep B and C was confirmed by doing HBsAg and
Anti HCV through ELISA

10.  Total of 130 children of thalassemia major
2-15 years of age (mean age 9.4 +_ 4.3yrs)
were enrolled.
Variables
 Gender
 Age
 Number of red cell concentrate transfusion
 HBsAg and Anti HCV antibodies

11. . Diagnosed thalassemia major with more than
10 blood transfusions (either whole blood or
red cell concentrate

12.  thalassemia major patients with splenectomy

13. Study results:
 Out of 130 Hepatitis B was found in 8 (6.2%)
patients and hepatitis C in 27 (20.8%) patients
while 95 (73.0%) cases were negative
Demographic results:
 Out of 130 subjects, 69 (53.0%) patients were
male while remaining 61 (47.0%) were female.
(male and female ratio of 1.2:1).
.

14. Total Hep B
positive
Hep c
positive
Negative
130 8 (6.2%) 27 (20.8%) 95 (73%)

15.  1 patient of hepatitis B and 3 patients of
hepatitis C had 10-20 RCC transfusions
 2 patients of hepatitis B and 6 patients of
hepatitis C had 21-30 RCC transfusions
 5 patients of hepatitis B and 18 patients of
hepatitis C had > 30 RCC transfusions.

16.  Children with transfusion > 20 were more
prone to develop hepatitis B and C (n= 31)
than children with transfusion less than 20
(n=4) and it is statistically significant p
<0.05.

17.  Thalassemia management need multi
disciplinary approach
 Blood transfusion is part and parcel in
thalassemia major patients
 It results in transmission of infections like
hep B and C
 More prevalent in developing countries due to
poor donor screening for communicable
diseases

18.  In develped countries thalassemia treatment
is stem cell transplantation
 Due to lack of facilities for the washed or
leukoreduced blood products, thalassemic
patients also experience severe blood
transfusion reactions

19.  In current study out of 130 subjects, 27
(20.8%) were found to be positive for
hepatitis C and 8 (6.2%) were found positive
for hepatitis B.
 In a regional study conducted in India on
forty multitransfused Thalassemic patients,
positivity for HBV was 18 (45%), and hepatitis
C virus (HCV) was 7 (17.5%),.

20.  In contrast to our study where
hepatitis C was more prevalent ,the regional
study showed the opposite results where
hepatitis B positive patients were higher in
number. One reason for this is that screening
for hepatitis C was started later in Pakistan.

21.  Ocak et al carried out a study in Malaysia
demonstrated that HBV positivity was 0.75%,
and HCV positivity was 4.5%
 One study from Iran reported prevalence of
anti-HCV positive 19.3% and HBs Ag positivity
in 1.5%.
 In Tehran showed the prevalence of HCV
positive in beta thalassemic patients as 11%
in 2005.
 In Kerman, the prevalence was 31%.
 A study in Iraq showed 10.4% anti- HCV
positive patients of thalassemia

22.  The prevalence of HCV is still very high
among frequent blood recipients like
thalassemia major patients.
This may be attributed to late starting of
screening for HCV antibody in donated blood
bags compared to that of HBV.
no vaccine is available so far for protection
against HCV

23. Merits:
 Appropriate study design
 Appropriate sample size
 Practical
 Achieving its objective
 Inclusion and exclusion criteria is well defined
 Purpose well defined

24.  Funding source disclosed
 Results discussed acc to objective
 Research findings compared with other
studies
 Limitations of study mentioned

25. Confounding variables
hep B and C status of mother

26.  Single centered
 Hospital based
 Not true reflection of community
 Study population not defined
 Sampling technique not defined

27.  The results of our study in comparison of
other studies clearly showed that Hepatitis B
and Hepatitis C were found to be common in
multi transfused Thalassemia patients and
frequency of HCV is more common.
 Improving the basic socioeconomic
indicators, establishing a proper screening
program for blood donors of thalassemic
societies and sensitization of individual
thalassemic patients is required.

28.  General public and patient awareness
regarding safe blood donation, proper
screening should be done by holding
seminars at community levels and proper
media campaigning and timely Hepatitis B
vaccination.

29.  Proper Donor screening
 Basis of sample size could have been
mentioned
 Study could be done at multiple centers and
community level for better reflections of hep
B and C prevalence
 National level campaign on awareness and
prevention of Hepatitis B and C

30. ANY SUGGESTIONs ???