Chronic Hepatitis C Infection In A Patient With Bone Marrow Hypoplasia

Main Category: Liver Disease / Hepatitis
Also Included In: Alcohol / Addiction / Illegal Drugs;  Sexual Health / STDs;  Arthritis / Rheumatology
Article Date: 24 Sep 2008 - 12:00 PDT

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HCV is acquired by intravenous drug abuse, sexually or via blood transfusion (rare nowadays due to the effective screening of blood products before transfusion). HCV is known to cause chronic infection in 80% - 90% of the patients becoming infected. Patients present with varying degrees of altered liver function ranging from mild cirrhosis to necrosis (liver cell death). Several factors namely male gender, older age at infection, excessive alcohol consumption and secondary hemochromatosis (excessive accumulation of iron in liver cells secondary to blood transfusion) enhance the fibrotic process. Furthermore, progression to cirrhosis is more rapid in patients with compromised immunity, hepatic steatosis, obesity and diabetes. Interestingly, viral factors such as viral load and genotype (6 types for HCV) do not influence the fibrosis progression Presently, evidence is accumulating on the role of HCV in association with other diseases, such as cryoglobulinemia, rheumatoid arthritis, thyroiditis to mention a few.

An article published in the World Journal of Gastroenterology addresses this report. The research team led by Prof. Kavitha Chandrikakumari from Centre Hospitalier Universitaire de Liege presentd a case of chronic HCV infection which was acquired by blood transfusion during childhood for the patient's anaemia secondary to bone marrow hypoplasia. However, the despite long duration of illness and having high serum ferritin (biological marker of iron content in the body) and cryoglobulins in her blood, the liver function remained normal through out the follow up. Patient had arthralgias and paraesthesia. Nonetheless arthritis or neuropathy was not demonstrated objectively. The patient had a normal staging on fibrotest and fibroscan (painless and non-invasive alternative to liver biopsy for assessing liver fibrosis). Chronic HCV induced translocation of immunoglobulin genes between chromosomes 14 and 18 was also negative in the patient. This translocation is known to induce B-lymphocyte proliferation and which then may progress to lymphoma (malignancy of lymphoid cells).

Reports from earlier studies in children under immunosuppression (induced by chemotherapeutic agents for the treatment of leukaemia) acquiring HCV through blood transfusion stated that these patients might not develop an immune response that could cause chronic injury. Although, this postulate was abandoned due to several conflicting reports, it is supportd in view of the normal liver function and absent fibrosis in the patient with bone marrow hypoplasia.

Chronic HCV infection might present with serious extra-hepatic manifestation rather than as hepatic disease itself. Patients immunological status might influence the extend of liver injury. HCV could be responsible for the rheumatology problems like arthritis, fibromyalgia and vasculitis.

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Article adapted by Medical News Today from original press release.
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Reference: Bethlen S, Chandrikakumari K, de Leval L, Giot JB, Mukeba D, Leonard P, Frippiat F, Meuris C, Delwaide J, Moutschen M. Chronic hepatitis C infection in a patient with bone marrow hypoplasia. World J Gastroenterol 2008; 14(26): 4238-4240 http://www.wjgnet.com/1007-9327/14/4238.asp

Correspondence to: Kavitha Chandrikakumari, Dr, Department of Infectious Diseases and Internal Medicine, Centre Hospitalier Universitaire de Liege, Service des Maladies Infectieuses et Medecine Interne, C.H.U, B35, Domaine du Sart-Tilman 4000, Belgium.

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection. It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

About The WJG Press

The WJG Press mainly publishes World Journal of Gastroenterology.

Source: Lai-Fu Li
World Journal of Gastroenterology