الفهرس 
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Abstract
Thalassemia is one of the most common single gene disorders and it
is widely distributed in the Meditrerranean region .
Beta thalassemia major is the term applied to patients who have
either no effective production (as in homozygous β0 thalassemia) or
severely limited production of beta globin. These are the patients
originally described by Cooley (Cooley’s anemia). Starting dur ing the
first year of life, they have profound and life-long transfusion-dependent
anemia.
This inherited disorder makes many complications as iron overload,
cardiac, hepatic, endocrine, renal, pulmonary, vascular, skeletal changes,
extramedullary hematopoiesis and blood transfusion complications.
The mainstays of therapy for beta thalassemia major are chronic
hypertransfusion combined with iron chelation, this leading to face
complications of transfusion as hepatitis B or C transmission and liver
affection.
With the increasing number of patients suffering from chronic liver
disease from HBV and HCV, which may progress to cirrhosis with all its
complications; clinicians and patients require accurate information about
the degree of liver fibrosis, to guide management decisions, monitor
disease activity, and predict outcome.
Liver biopsy, which is considered the ultimate standard, has three
major limitations: a risk of adverse events, sampling error, and intra and
inter observer variability. The factors associated with this inaccuracy of
liver biopsy include: the heterogeneous nature of chronic liver disease;
the relatively small size of liver biopsy sample compared to the size of
liver (1/50,000), or even the size of a nodule as in macronodular cirrhosis,
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Summary
which is > 3mm; and the experience of the histopathologist. These
limitations of biopsy have led clinical investigators to study alternative
methods to investigate liver disease.
Noninvasive markers are the most widely used alternative to liver
biopsy to stage chronic liver disease. Serum markers of liver fibrosis offer
an attractive alternative. They are less invasive than biopsy, with no risk
of complications, eliminate sampling and observer variability. An
alternative method to stage chronic liver disease is elastography, or
measurement of hepatic elasticity or stiffness.
Our study done on 30 thalassemic children who had HCV or HBV
in which fibroscan is done and other non invasive parameters which are
APRI test and Forns index to evaluate liver fibrosis or cirrhosis in these
patients.
The results of our study revealed that:
- Our study revealed that there is highly strong correlation (p<
0.0001) between fibroscan and age ,weight, ALT, Serum albumin and
prothrombin concentration while significant correlation (p < 0.05)
between fibroscan and height, HC, AST and serum ferritin .
- Our study also showed highly significant correlation (p <0.001)
between fibroscan and (age , weight) and only significant correlation ( p<
0.05) with ( height , HC).
- Our study revealed that the mean value of fibroscan showed a
highly significant correlation according to liver stiffness with highest
level in patients with cirrhosis .
- Our results indicated that liver stiffness measurements could be
used to evaluate liver fibrosis in chronic liver diseases, whatever the
etiology , also it correlates with fibrosis stages with increasing reliability
in cases with more extensive fibrosis or cirrhosis. Thus , fibroscan could
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Summary
be a promising non invasive method for assessing advanced fibrosis in
patients with chronic liver diseases.
- Our study showed that highly significant correlation (p<0.001)
between APRI test and (platelet count, ALT, AST, serum ferrit in ) and
significant correlation (p<0.05) between APRI test and (serum albumin &
prothrombin concentration).
- In our study we found that there is highly significant correlation
between Forns index and platelet count while no significant correlation
with other parameters . No significant correlation between Forns index
and liver fibrosis.