Transcript Hepatitis C Infection - Thalassemia Center

Hepatitis C Infection
By: S/N Maryam Omar
Introduction
 Thalassemia
patient require life long blood
transfusion to sustain their growth and development
during childhood.
 Transfusion exposes these patients to increased risk
of blood borne viruses (the most important one is
HCV infection).
 Iron overload and HCV infection are the two main
causes of chronic liver fibrosis in patients with
Thalassemia, which is a common cause of death after
the age of 15 in these patients.
 Hepatitis
C is an RNA
virus (HCV) affects the
liver.
 often asymptomatic
 chronic infection can
progress to scarring of
the liver (fibrosis), and
advanced scarring
(cirrhosis) which is
generally apparent after
many years.
 In some cases, those
with cirrhosis will go on
to develop liver failure
or liver cancer.
The
hepatitis C virus (HCV) is spread by
blood-to-blood contact.
An estimated 270-300 million people
worldwide are infected with hepatitis C.
No vaccine against hepatitis C is available.
The existence of hepatitis C (originally
"non-A non-B hepatitis") was postulated in
the 1970s and proved conclusively in 1989.
Hepatitis C is a strictly human disease.
Acute:
 the first 6 months after
infection with HCV.
 60% to 70% of people
infected develop no
symptoms during the
acute phase.
 the minority of patients
experience mild and
nonspecific symptoms.
Symptoms
of acute hepatitis C infection
include:
 decreased appetite
 fatigue
 abdominal pain
 jaundice, itching
 flu-like symptoms.
Chronic:
 -Is infection with the hepatitis C virus
persisting for more than six months.
 - often asymptomatic and it is mostly
discovered accidentally.
-Generalized signs and symptoms include
fatigue, flu-like symptoms, joint pains, itching,
sleep disturbances, appetite changes, nausea,
and depression.
Diagnosis
Hepatitis
C testing begins with serological
blood tests used to detect antibodies to
HCV.
 Anti-HCV antibodies can be detected in 80%
of patients within 15 weeks after exposure, in
>90% within 5 months after exposure, and in
>97% by 6 months after exposure.
 Overall, HCV antibody tests have a strong
positive predictive value for exposure to the
hepatitis C virus
All
persons with positive anti-HCV antibody
tests must undergo additional testing for the
presence of the hepatitis C virus itself to
determine whether current infection is
present.
The presence of the virus is tested for using
molecular nucleic acid testing methods such as
polymerase chain reaction (PCR) which
have the capacity to detect not only whether
the virus is present, but also to measure the
amount of virus present in the blood (the
HCV viral load).
Other
investigation includes:
FBC
Liver
enzymes (AST & ALT)
Liver biopsy
Auto-antibody screen
HCV genotype.
Treatment
 There
is a very small chance of clearing the
virus spontaneously in HCV carriers
However, the majority of patients with
chronic hepatitis C will not clear it without
treatment.
Treatment
Combination of :
 Pegylated interferonalpha-2a or Pegylated
interferon-alpha-2b
(brand names Pegasys
or PEG-Intron)
&
 The antiviral drug
ribavirin for a period
of 24 or 48 weeks,
depending on hepatitis
C virus genotype.
Cont..
Sustained
cure rates (sustained viral
response) of 75% or better are seen in
people with HCV genotypes 2 and 3 with
24 weeks of treatment.
Sustained responses are rarer with other
genotypes, genotype 1 & genotype 4 .
The Case
A
20 years old male know case of Thalassemi
, chronic hepatitis C infection & secondary
hypothyroidism on regular Rx.
HCV RNA showed ve+ since 1995
Liver biopsy was done in 2004 : chronic HCV
grade 2 & hemosiderosis grade 3.
ALT & AST were constantly elevated.
Baseline Ferritin 1820ng/ml.
He
was started on Peg. Interferon
180mcg/once per week & Ribavirin 400mg
BD from RH in 2004, but he received 3
dose only & went to PK.
On April 2007 he was restarted with the
Rx.
On Feb. 2008 Rx was stopped as HCV
RNA was negative.
During
the course of RX he developed
Neutropenia .
To over come this he was started on
GCSF(Granulocyte colonystimulating factor) subcutaneous
injection.
Interferon
 Interferon
is a specific protein that is no
stranger to the human body. In fact, the
human body is constantly making
interferon, and makes even greater amounts
when trying to fight off an intruder, such as
a virus.
How Does it Work?
It
helps defeat the virus in three ways:
1. By attaching to healthy cells to help defend
against invading viruses.
2. By helping the immune system to stop the
virus from multiplying.
3. By assisting the body in ridding itself of
infected cells while preventing healthy cells
from being infected.
Side Effects
* irritability and insomnia
* high fever and chills
* fatigue
* headaches
* decreased appetite, nausea and vomiting
* weight loss
* muscle aches
* bone marrow suppression
* weight and hair loss
* depression and mood changes
* decreased white blood cells and platelets
* elevated liver enzymes
* difficulty concentrating and impaired memory
Nursing care plan
 Knowledge
deficit:
 Describe the Hepatitis C disease process
 Educate patient on chronic liver disease
process
 Instruct patient on signs & symptoms to
report to their health care provider
 Risk
for Infection
Monitor for signs of infection
Administer medicine as per order
Encourage intake of protein- and calorie-rich
foods. This maintains optimal nutritional
status.
Encourage fluid intake of 2000 ml to 3000
ml of water per day.
 Altered
Mood States
 Assess mood and affect regularly. Affect is
defined as an emotion that is immediately
expressed and observed.
 Referal when appropriate