166 THE RELATIONSHIP BETWEEN DISTURBED LIVER FUNCTION, IRON AND MARKERS OF HEPATITIS B UIRUS INFECTION IN BRITISH CHILDREN WITH BETA THALASSAEPIIA

Abstract

Although chronic liver dysfunction in β Thalassaemia major has been associated with transfusion induced iron overload. Chronic Hepatitis B virus (HBV) infection has also recently been implicated. We, therefore, studied 16 children (8 male, 8 female) aged 1-14 years, to assess the influence of iron overload measured by serum ferritin and the volume of transfused blood, and the presence of markers of HBV infection (HBs Ag, HBc Ab, HBs Ab) on liver dysfunction. Thirteen children had elevated serum transaminases; 6 of these had received > 10D units of blood and had had serum ferritin levels of > 6,000mcg/L. All 16 received chelation therapy with a fall in serum ferritin levels from a maximum of 1280-13, 900mcg/L to a minimum of 370-5, 450mcg/L. Concommitant improvement in liver function occured in 10. Although 11 patients had visited HBV endemic areas and 6 had been transfused there, only 2 developed markers of HBV infection. Both had clinical, biochemical and serological evidence of acute HBV infection; they had abnormal liver function prior to the HBV infection, and transaminases returned to these levels after the acute HBV infection. Thus in children, iron overload rather than HBV infection is the major cause of chronic liver dysfunction. However, active immunisation against HBV is necessary to protect these children who commonly receive transfusion whilst in endemic areas.