Serum aminotransferase levels as an indicator of the effectiveness of venesection for chronic hepatitis C

Background/Aims: Iron cytotoxicity may play an important role in chronic hepatitis C. The effects of venesection suggest that a slight iron overload contributes to hepatic injury in subjects infected with hepatitis C virus. A better indication of the efficacy of venesection was studied in patients with and without overt iron overloading. Methods: All 40 patients had chronic hepatitis C but none had hemochromatosis of a known etiology. A serum ferritin level of 10 ng/ml or less was chosen as the treatment goal. A mean blood volume of 2400±1100 ml was removed during treatments lasting 5±3 months. Results: Treatment significantly reduced the mean serum levels of alanine aminotransferase activity from 128±74 to 63±28 IU/l (p<0.01). The baseline enzyme activity was highly correlated with reduction in activity after treatment (r=0.94, p<0.01), but the baseline levels of ferritin and histochemistry for iron showed poor correlation with the reduction in enzyme activity (r=0.63 with p<0.01 and R=0.38 with p<0.05, respectively). Conclusions: Thus, serum levels of aminotransferases were a more important indicator for venesection than conventional indices of iron overload, probably because cytotoxic iron includes some reactive iron species rather than stored iron alone.