Chronic hapatits C is a major medical issue because it is a world
wide progressive preventable and treatable disease with a lot of major
complications and problems of the disease and therapy ,HCV is a global
health problem approximately 3% of word population, Egypt has the
highest HCV prevalence in word 10-20% of general population are
infected , the transmission of HCV is primarily through exposure to
infected blood.
Chronic hepatitis C infection can cause cirrhosis, liver failure,
HCC and extra hepatic manifestation like hematological disorder
,autoimmune disorder, diabetes mellitus, renal disease, ocular disease ,
dermatolological disease and musculoskeletal disease.
Diagnosis of chronic HCV infection by full history taking, general
and local abdominal examination and investigation by biochemical
assessment of liver function included (serum aminotransferase enzymes,
serum albumin, serum bilirubin, prothrombin time), virological assay for
HCV included(enzyme immunoassay, RIBA and PCR for HCV
RNA),liver biopsy for histological grading and fibrosis stages and
recently fibroscan for evaluation of liver stiffness measurement.
The currant standard treatment of HCV is the combination of
pegylated interferon (IFN) alfa and ribavirin. The efficacy endpoint of
hepatitis C treatment is the "sustained virological response" (SVR),
defined by the absence of detectable HCV RNA in serum as assessed by
an HCV RNA assay with a lower limit of detection of 50 lU/ml or less 24
١١٥
weeks after the end of treatment. Responses to therapy in chronic
hepatitis C can be categorized as biochemical as shown by
1- normal alanine aminotransferase (ALT) levels
2- virological as shown by absence of detectable HCV RNA
3- hislological as shown by improvements in liver biopsy results.
The interferons have multiple effects like antiviral effect
,immunomodulatory effect ,antiproliferative effect and antifibrogenic
effect.
Interferon-α has a myelosuppressive effect and decrease in
peripheral blood counts occur in almost all patient ,Thrombocytopenia is
one of the most common hematological complication with chronic liver
disease and also to antiviral therapy.
This study aims to monitor occur thrombocytopenia after interferon
therapy so should measure platelets level before ,at weekly intervals for 4
weeks, then every 3 months during treatment and 6 months latter
This study included 1000 patients with chronic hepatitis C virus
infection who were treated by interferon and ribavirin in Liver Research
Centre, Tanta Fever Hospital during the period from June 2007 to June
2009, the data of all patients were collected from their files included age
,sex, liver biopsy, laboratory investigation included (serum
aminotransferase enzymes, serum albumin, serum bilirubin, prothrombin
time, WBC, platelet count, PCR for HCV RNA).
This study shows majority in 750 males and minority in 250
females and response to interferon therapy in females higher than males .
١١٦
Also, that the response to treatment with interferon is significant
higher in patients wit low necro- inflammatory score, response to
treatment with interferon is significant higher in patients with low fibrosis
stage, there is significant post-therapy thrombocytopia in all patients
groups(responder, resistant 12 and resistant 24) ,there positive correlation
between the platelet count and the viral load an both pre and post-therapy
groups there positive correlation between WBCs and platelet count in the
pre-therapy treatment and also there is significant hypoalbuminemia in
low platelet count .
And in this study proved occurrence post therapy
thrombocytopenia by comparison platelet count before and during and
after interferon therapy. |
