Hepatitis and liver issues can arise in Thalassemia patients

Many people with thalassemia develop liver-related issues (sometimes called hepatic issues) that can
become a problem if left undiagnosed and untreated. Knowing what steps to take to help prevent liver
issues, and knowing what to do to improve your health if they arise, is very important for people with thalassemia.

Understanding of and treatment for liver issues has improved greatly over the years, so patients today are dealing with these issues in a positive manner. Patients whose care is handled medical experts with specific experience in thalassemia are in an excellent position to receive the kind of care that can minimize the problems associated with liver issues and ensure optimal outcomes.

Why do people with thalassemia sometimes have liver issues?
People with thalassemia suffer from iron overload, either as part of their bodies’ attempts to combat
anemia by creating more red blood cells (which contain iron) or from the transfusions of red bloods cells that they receive Hepatitis and Liver Issues in Thalassemia. Unless removed, this excess iron cannot leave the body. It stays in the blood or settles in organs, such as the heart and liver.

One of the liver’s functions is to store reserves of iron for when the body needs it, so in some ways it is already “welcoming” to iron; but the amount it receives from a patient who does not properly chelate is far more than it can handle. If too much iron settles in the liver, it “clogs” it, leading to scars known as “fibrosis,” and keeping it from functioning properly. If the liver becomes severely injured and scarred, it is said to have “cirrhosis,” a serious complication. In addition, some patients develop liver complications because they become infected with a virus such as hepatitis A, B or C. Hepatitis B and C can cause fibrosis and cirrhosis. Hepatitis A rarely causes severe damage on its own, but it can worsen the damage caused by hepatitis C. One route of transmission for all three of these viruses is from blood transfusion from infected donors.

 

There are vaccinations for hepatitis A and B although, in some cases, a person may still contract the disease even after vaccination. At this time, there is no effective vaccination for hepatitis C. Reversing fibrosis and cirrhosis is difficult. So making sure that the blood that is transfused is properly tested for hepatitis will significantly reduced the chance of getting infected with hepatitis virus. In most instances, the course of treatment is aimed at preventing damage from worsening.

Often a person may be infected with a hepatitis virus and have no symptoms; in such cases, hepatitis B or C can go undiagnosed for many years. (Symptoms of hepatitis A usually show up within 2 months.) When symptoms of hepatitis are present, the most common include:
Low-grade fever, Headache, Fatigue, Nausea/vomiting, Diarrhea, Loss of appetite, Stomach pain (usually on the right side, slightly below the ribcage) and bloating, Muscle aches, Joint pain, Itchy skin, Dark urine, Pale (gray-ish) stool, Jaundice (yellowing of the skin and/or eyes), Mood swings, Night sweats

Symptoms of cirrhosis may include:
Redness on the palms of your hands, Red spider-like rash on the chest, shoulders or face, Swelling in the stomach, legs or feet (due to fluid build-up), Muscle loss, Weight loss, Frequent infections, Fatigue, Tendency to bruise easily, Itching, Frequent nosebleeds, Blood in stool or urine, Confusion or memory problems, Jaundice.

How are liver complications diagnosed?
There are a number of tests involved in assessing the health of the liver that can provide information about possible complications. Every three months, a Liver Function Enzyme Screening (AST/SGOT, ALT/SGPT) should be taken. This test can act as an “early warning system” to alert your doctor to any potential problems.
If the ALT levels are higher than they should be, your doctor should consider repeating these tests every month. If the ALT is persistently elevated for 6 months or more, a liver biopsy should be considered.

There are a number of other liver related tests that should be a part of every thalassemia patient’s annual comprehensive care evaluation. Whether a patient undergoes each of these tests every year depends upon certain factors, but the list includes:
Hepatitis C Antibody test
Hepatitis C RNA viral load
Hepatitis B panel
Hepatitis A panel
HIV test
Serum AFP and abdominal ultrasound
Liver iron assessment via biopsy or via MRI

What is involved with these tests?
Most of these tests are blood tests. An abdominal ultrasound is an examination of internal organs with a non-invasive external device that creates a sound wave-generated picture of the liver.

A liver biopsy is a procedure in which a small portion of the liver is removed and examined for evidence of iron loading, scarring or other problems. Typically, a needle is inserted through the ribcage or below the ribcage and a spring loaded needle biopsy of liver tissue is obtained, using ultrasound guidance. Sedation and local anesthesia is commonly used for this procedure. For children under six years of age, general anesthesia is recommended. MRI (Magnetic Resonance Imaging) is a non-invasive iron measurement called R2 or Ferriscan. The patient lies on a table that moves inside an MRI machine. The machine takes “pictures” of the organ. This is a painless procedure. The patient must lie still and hold his/her breath while each picture is taken. If the patient is not old enough to do so, general anesthesia is given during the imaging. While MRI machinery is very common at hospitals, today iron readings can only be done at specific thalassemia treatment centers which have the necessary software.