Clinical, immunological and histological aspects of non-A, non-B hepatitis in haemophiliacs

Although the incidence of symptomatic hepatitis associated with jaundice in patients with congenital coagulation disorders is low1,2, several reports have demonstrated that many of these patients have asymptomatic liver disease. Mannucci et al., in 19755 showed increased transaminases in more than 40% of haemophiliacs and Levine et al., in 19764 found similar abnormalities in 68% of patients. The latter study included 33 intensively treated patients from the Royal Free Hospital who had received cryoprecipitate only and who had a 48.5% prevalence of abnormal liver function tests. More recently, in a survey of 76 patients with severe haemophilia A (Factor VIII < 1%) registered at the Royal Free Hospital Haemophilia Centre, 92% were found to have abnormal aspartate transaminase levels on random testing. The prevalence of abnormalities was similar in patients who had received NHS concentrate only (100%) and those who had received commercial Factor VIII preparations (96%), but slightly lower in those who had received cryoprecipitate only (80%). Seven untreated patients with mild haemophilia had normal liver function tests. Although the number of patients who had received NHS concentrate or cryoprecipitate only was smaller than the number who had received commercial concentrate, and patients receiving cryoprecipitate only were in general transfused less frequently than those receiving concentrate.