1. Hepatitis C Infection By: S/N Maryam Omar

2. 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.

3.  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.

4.  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.

5. 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.

6.  Symptoms of acute hepatitis C infection include:  decreased appetite  fatigue  abdominal pain  jaundice, itching  flu-like symptoms.

7. 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.

8. 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

9.  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).

10.  Other investigation includes:  FBC  Liver enzymes (AST & ALT)  Liver biopsy  Auto-antibody screen  HCV genotype.

11. 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.

12. Treatment Combination of :  Pegylated interferon- alpha-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.

13. 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.

14. The Case  A 20 years old male know case of Thalassemia, 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.

15.  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.

16.  During the course of RX he developed Neutropenia.  To over come this he was started on GCSF(Granulocyte colony- stimulating factor) subcutaneous injection.

17. 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.

18. 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.

19. 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

20. 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

21. 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.

22. Altered Mood States Assess mood and affect regularly. Affect is defined as an emotion that is immediately expressed and observed. Referal when appropriate