A case of a girl presenting with fever, cytopenia, liver dysfunction, hepatosplenomegaly, and hemophagocytosis in the bone marrow

A total of 161 patients transplanted between 1978 and 1991 and who had survived at least 2 years after allogeneic bone marrow transplantation (BMT) were studied. Of 161 surviving patients, 28 (17.4%) were positive for hepatitis C virus (HCV) either by serology or polymerase chain reaction (PCR). Twenty-five patients were positive for HCV RNA by PCR, and 26 of the 28 patients had HCV antibodies detected by enzyme-linked immunosorbent assay (ELISA). The median follow-up time of HCV-positive patients was 6.1 years (range, 2.8 to 14.0 years). There was no difference in the frequency or degree of liver dysfunction between patients who were PCR-positive or -negative before BMT. Six patients developed severe liver dysfunction after BMT, and five of these patients did so after discontinuation or tapering of immunosuppression. No patient has developed liver failure. Serum transaminases were abnormal at the time of last follow up in 19 of 28 (68%) patients. Fifteen patients have had liver biopsies. No biopsy showed development of cirrhosis. We conclude that HCV is not a major contributing factor to morbidity and mortality during the first 5 to 10 years after allogeneic BMT.

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Humoral factors in aplastic anemia: relationship of liver dysfunction to lack of serum stimulation of bone marrow growth in vitro

Blood ◽

10.1182/blood.v51.3.397.bloodjournal513397 ◽

1978 ◽

Vol 51 (3) ◽

pp. 397-414

Author(s):

JE Karp ◽

LP Schacter ◽

PJ Burke

Keyword(s):

Bone Marrow ◽

Aplastic Anemia ◽

Liver Dysfunction ◽

Humoral Factors ◽

Serum Stimulation ◽

Relationship Of ◽

Stimulation Of

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CHRONIC MARROW FAILURE, MYELOSCLEROSIS AND EXTRAMEDULLARY HEMATOPOIESIS

Blood ◽

10.1182/blood.v5.4.329.329 ◽

1950 ◽

Vol 5 (4) ◽

pp. 329-347 ◽

Cited By ~ 84

Author(s):

JOHN P. WYATT ◽

SHELDON C. SOMMERS

Keyword(s):

Cardiovascular Disease ◽

Bone Marrow ◽

Blood Loss ◽

Liver Dysfunction ◽

Bone Marrow Failure ◽

Hematopoietic Cells ◽

Extramedullary Hematopoiesis ◽

Toxic Chemicals

Abstract Thirty cases, including 20 autopsied, of chronic bone marrow failure, myelosclerosis and osteosclerosis have been presented and compared with similar reports in the literature. The bone marrow histopathologic sequence observed involved repeated necrobiosis of maturing hematopoietic cells, followed by overgrowth of marrow reticulum and frequent ossification. Immature erythrocytes and leukocytes were often found in the circulation, and extrameduallary hematopoiesis was characteristic. One case was complicated by leukemia. Etiologic factors implicated included exogenous toxic chemicals, liver dysfunction, endocrine abnormalities, blood loss or destruction and cardiovascular disease. Suspicion was directed toward the pathogenetic importance of protracted bone marrow exposure to certain substances normally conjugated rapidly in the liver and excreted.

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Detection of hepatitis G virus from serum and liver of a patient with long-term liver dysfunction after autologous bone marrow transplantation

Bone Marrow Transplantation ◽

10.1038/sj.bmt.1700782 ◽

1997 ◽

Vol 19 (10) ◽

pp. 1053-1057 ◽

Cited By ~ 3

Author(s):

JF Tomás ◽

E Rodriguez-Iñigo ◽

J Bartolomé ◽

A Madejón ◽

M Fogeda ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplantation ◽

Liver Dysfunction ◽

Marrow Transplantation ◽

Autologous Bone Marrow Transplantation ◽

Autologous Bone Marrow ◽

Hepatitis G Virus ◽

Autologous Bone ◽

Hepatitis G

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Hepatitis C and G Virus Infection and Liver Dysfunction After Allogeneic Bone Marrow Transplantation: Results From a Prospective Study

Blood ◽

10.1182/blood.v90.3.1326.1326_1326_1331 ◽

1997 ◽

Vol 90 (3) ◽

pp. 1326-1331 ◽

Cited By ~ 2

Author(s):

Elena Rodriguez-Iñigo ◽

José-Francisco Tomás ◽

Valle Gómez-Garcı́a de Soria ◽

Javier Bartolomé ◽

Inmaculada Pinilla ◽

...

Keyword(s):

Bone Marrow ◽

Hepatitis C ◽

Bone Marrow Transplantation ◽

Virus Infection ◽

Prospective Study ◽

Liver Dysfunction ◽

Allogeneic Bone Marrow Transplantation ◽

Hcv Rna ◽

Allogeneic Bone ◽

A Prospective Study

Acute and chronic liver dysfunction is common after allogeneic bone marrow transplantation (BMT). Although toxicity, graft versus-host disease (GVHD), and viral infections are the major causes, etiologic diagnosis is difficult and often remains unknown. We conducted a prospective study to establish the role of the infection with both the hepatitis C virus (HCV) and the recently discovered hepatitis G virus (HGV) in liver dysfunction after BMT. From January 1994 to December 1995, 59 patients who had undergone an allogeneic BMT at our institution were enrolled in the study. HGV-RNA was identified in serum by nested polymerase chain reaction (PCR), and HCV was studied by the presence of second generation enzyme-linked immunosorbent assay (ELISA)-antibodies and HCV-RNA by nested PCR. HGV-RNA was detected in 25 patients (42%) (before BMT in 18 and after BMT in 7). HCV-RNA was present in 12 patients (20%) (before BMT in 11 and after BMT in one). The presence of HCV-RNA and HGV-RNA was clearly associated with a previous history of blood transfusions. No significant association was found between viral infection and acute liver toxicity. Some degree of liver dysfunction was present 6 months after BMT in 25 of 40 evaluable patients (62%). Long-term liver dysfunction was more common among patients infected with HCV alone (3 of 4) or with both HCV and HGV (3 of 3) than in those infected with either HGV alone (eight of 13) or with no virus infection (10 of 20). We found a high prevalence of HGV infection in our BMT population. However, no role for HGV in liver disease could be established in this study, and the relationship between HGV infection and liver dysfunction requires further clarification.

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