Mixed Cryoglobulinemia in Hepatitis C Virus Infected Children

Abstract

nfection with hepatitis C virus (HCV) can lead to several extrahepatic manifestations (EHM). Hematologic diseases such as cryoglobulinemia and lymphoma, autoimmune disorders such as thyroiditis, renal diseases, dermatologic conditions such as lichen planus and porphyria cutaneatarda, Lymphoproliferative disorders. Cryoglobulinaemia is among the most common and closely linked extrahepatic HCV manifestations and is most often a mixed cryoglobulinaemia of type 2 or 3. Considered a lymphoproliferative disorder, it is thought to result from chronic stimulation and over production of B cells producing immunoglobulin. We aimed to study the frequency of occurrence of mixed cryoglobulinemia (MC) manifestations among hepatitis C virus infected children attending the Pediatric Hematology Oncology Unit, Ain Shams University, to assess its relation to the level of hepatitis C viremia and to compare its frequency among hepatitis C virus beta thalassemia and childhood cancer survivors patients. This cross sectional study included 50 Hepatitis C virus infected patients; 25 Beta thalassemia patients and 25 childhood cancer survivors patients; recruited form the haematology/oncology clinic Children’s hospital Ain Shams University. Methods: Data was gathered from medical records of the patients and from patients and/or legal guardians including: History with special emphasis on: Age of onset,type of cancer and duration,transfusion history, mean serum ferritin, history of splenectomy and time of the procedure, calculation of Aspartate amino transferase Platelets Ratio index (APRI score), hepatits C virus infection history, history of drug therapy for hepatitis C infection and chelation therapy, history of extrahepatic manifestations of HCV infection. Thorough clinical examination laying stress on weight and height, sexual maturity rating and complete examination of all systems. Laboratory investigations (Qualitative cryoglobulin assessment, liver function tests (ALT, AST), Kidney function tests: (BUN) Blood urea nitrogen, (Urea), serum creatinine, serum albumin level and HCV RNA by PCR. Group 1: Beta thalassemia major (25 patients), they were 10 males (40.0%) and 15 females (60.0%) (Male to female ratio was 2: 3). Their age at evaluation ranged between 3 – 19 years with a mean (13.60 years  4.00) Group 2, Cancer survivor group (25 patients) they were twenty males (80 %) and five females (20 %).Their age at evaluation ranged from 6 – 19 years with a mean( 10.56 years  3.10). Their age at diagnosis ranged between 3 to 10 years. Fifteen patients (60.0%) had acute lymphoblastic leukemia (ALL), Five (20.0 %) had NH lymphoma, two (8.0%) Hodgkin Lymphoma, two (8.0%) neuroblastoma and one (4.0%) retinoblastoma patient.