Hepatitis, Type B in Haemophiliacs

Chronic hepatitis in haemophilia

Chronic hepatitis affects almost all haemophiliacs treated with non-virally inactivated clotting factor concentrates. The virus responsible is hepatitis C (HCV) and most patients have non-neutralising antibodies with circulating virus. Although the majority also have evidence of past infection with hepatitis B, less than 5% are chronic carriers of HBsAg. Chronic hepatitis C can be associated with severe and progressive liver disease but the development of complications is slow. Treatment with recombinant interferon alpha given subcutaneously normalises the liver function in 50% of patients, but 50% of responders relapse on stopping treatment. Liver transplantation is successful in patients with advanced liver disease and it offers the added advantage of phenotypic cure of the haemophilic state.

Prothrombin complex concentrates for clinical use

Prothrombin complex concentrates prepared for clinical use are reviewed with emphasis on frequently observed adverse reactions such as viral hepatitis and thromboembolic complications. Preparation procedures and quality control are described briefly, and the use of these concentrates in the treatment of hemophilia A patients who develop factor VIII inhibitors is also described. The causes of and methods for the detection of potential thrombogenicity are discussed and suggestions which may result in a safer product are made.

Antibody to hepatitis B surface antigen in haemophiliacs on long-term therapy with Scottish factor VIII

Thirty-five patients with haemophilia A were studied clinically and serologically between 1971-2 and 1975-6 for evidence of hepatitis B infection. One patient suffered from clinical hepatitis B, and a further eight patients showed antibody responses to hepatitis B surface antigen (HBsAg) consistent with exposure to HBsAg during this period. No evidence for HBsAg exposure was found in 14 patients, while the remaining 12 patients had high titres of antibody to HBsAg at both times and no inferences could be drawn about HBsAg exposure. All patients had received exclusively replacement factor VIII material prepared locally from HBsAg-screened voluntary Scottish blood donations. From the details of the therapy given we calculated that the rate of HBsAg seroconversion in these patients represented about 0.3 HBsAg-containing donations/1000 donations.