Prophylaxis of transmission
of hepatitis B virus with anti hepatitis B immune gamma ev in an
allogeneic transplant of hematopoietic precursors.
A. Romero, J. García, E. Clavero, AR.
López-Quiñones, T. Gallego , M. Jurado.
Servicio de Hematología, Hospital Universitario Virgen de
las Nieves Granada, Spain
Correspondence: Antonio Romero Aguilar, Servicio de
Hematología, Hospital Universitario Virgen de las Nieves,
Avda de las Fuerzas Armadas nº 2, !8014 Granada. Spain.
Phone: 00-34-958- 020161. Fax: 00-34-958-020169. E mail:
aromero9@navegalia.com
Text
The transmission of hepatitis B is a possible complication in the transplant of hematopoietic progenitors. Case report of a patient who received an allogeneic transplant of hematopoietic precursors from a sister who was Ag HBs+. Transmission of the virus was prevented by the ev administration of anti hepatitis B immune gamma globulin to the recipient. Hepatic complications are frequent in patients undergoing a transplant of hematopoietic precursors.1 Hepatitis B is one of these complications and this may be due to a reactivation of latent infections2 or transmission of the virus from Ag HBs+ donors. Even though in previously immunised patients it seems that the risk of reactivation is quite low,3 cases have been described of sudden hepatitis in these patients.4 Various treatments have been applied in an attempt to avoid this complication, including Lamivudin5 and Famiclovir,6 and certain guidelines have even been published with recommendations on how to handle these patients.7 The use of preparations of immunoglobulins immune to the hepatitis B virus as intramuscular formulations are difficult to apply in these patients because they present thrombocytopenia. The ev use of immune immunoglobulins has been suggested for these patients,8 but the experience is still quite limited. Our patient was a 43 year old woman diagnosed for acute lymphoblastic leukemia in December 1999 and subjected, in January 2001, to an allogeneic transplant of hematopoietic precursors of peripheral blood from an HLA identical sister because of active chemoresistant disease. The serology of the patient was: HBs- Ag, HBs+ Ac, HBc+ Ac, whereas that of the donor was: HBs+ Ag, HBs+ Ac, HBc+ Ac, HBe- Ag, HBe+ Ac. Faced with the risk of hepatitis B, it was decided to administer Gamma globulin immune hepatitis B anti virus (Hepuman®, Berna) to the recipient at the dose of 10,000 U/day ev for 10 days. On day +2 the patient presented clinical signs of veno-occlusive disease which was resolved with restricted water intake and diuretics. The patient died on day +67 from lung and brain invasive aspergillosis. The biochemical controls carried out at GOT levels were always normal, serological examinations were also performed every fortnight, the last 14 days before the death of the patient, and they always gave the same results: HBs Ag, HBs+ Ac, HBc+ Ac. In our case, in view of the risk of transmission of hepatitis B virus, our patient was administered a well tolerated therapy which proved to be effective; this leads us to believe that its effectiveness should be analysed in a larger series of patients.
