Jaundice and hepatitis B antigen-antibody in hemophilia.

Abstract

Overt hepatitis was found in 11.7 per cent of the hemophiliac population studied. In those who had received fractions prepared from pooled plasma, the incidence was 22 per cent. Concentrates of factor IX were associated with hepatitis about three times as often as were factor VIII fractions. Blood samples obtained during the acute phase of hepatitis were available from 12 of the 14 patients treated with factor VIII fractions and eight of the ten treated with factor IX concentrates. Two of the 12 samples from factor VIII deficient patients and seven of the eight from factor IX deficient patients were positive for HB Ag. Antibody (HB Ab) was found in six factor VIII deficient and one factor IX deficient patient with hepatitis. Severe diffuse intravascular coagulation (DIC) occurred in a factor IX deficient man who had been treated with factor IX fractions and who expired in hepatic coma.Multiple serum samples were available from 89 patients who had not had overt hepatitis but had received fraction therapy. Antigenemia was found in one hemophiliac and one afibrinogenemic. Antibody was found in 24 per cent of the factor VIII and 17 per cent of the factor IX deficient patients. Usually HB Ab appeared following therapy with plasma fractions and lessened or disappeared during quiescent periods only to recur after additional exposure to pooled plasma fractions. Remarkably, of the 113 patients who have received fraction therapy, 66 (58%) have not had hepatitis or developed circulating HB Ag or HB Ab.