Relationship between elevated liver enzyme with iron overload and viral hepatitis in thalassemia major patients in Northern Iran

OBJECTIVE: To determine the relationship between elevated liver enzymes with iron overload and viral hepatitis in thalassemic patients.

METHODS: This descriptive cross-sectional study was carried out in the thalassemic ward of Tonekabon Hospital, Mazandaran, Northern Iran from 20 April to 20 September of 2006. Patients were studied with respect to age, liver enzymes, anti-hepatitis C virus (anti-HCV) antibody, and hepatitis B surface antigen (HBsAg), transferrin saturation (TSAT), and blood transfusion index (multiplication of frequency and units of transfusion). Alanine aminotransferase (ALT) >/=40 U/L was considered elevated.

RESULTS: Sixty-five patients were evaluated (median age 19.51±8.9 years, range 4-54). Eleven patients were anti-HCV positive (16.9%). The mean serum ferritin was significantly higher in patients with ALT >/=40 (2553.08 ug/L versus 1783.7750 ug/L) (p=0.012). The mean ALT was significantly higher in patients with TSAT >60% (41.26 U/L versus 28.82 U/L) (p=0.021). The relationship between ALT >/=40 and anti-HCV positivity was statistically significant. The mean ALT was 60.91 U/L in anti-HCV positive ptients and 39.29 U/L in the negative group (p=0.001). The mean serum iron and transfusion index were significantly higher in anti-HCV positive versus negative patients (234.0 versus 195.4815; p=0.02), (1693.6 versus 1036.29, p=0.014).

CONCLUSION: Close association between elevated ALT with iron overload, transfusion index, age, and anti-HCV positivity in thalassemic patients of Tonekabon is recommended to re-evaluate transfusion and Desferal doses and therapies other than blood transfusion.