Clinical Spectrum of Hepatitis-Associated Cryoglobulinemia: Cross-Link between Hematological and Immunological Phenomena

The prevalence of cryoglobulinemia (CG) in Hepatitis C Virus (HCV) infection with and without superimposed renal failure is an acknowledged finding. This study chose to investigate some immunological and hematological features dictated by CG and End-stage Renal Disease (ESRD) onto the disease course and progression in a total of 47 HCV cases classified into a hemodialysis (HD, 25 cases) and non-HD (NHD, 22 cases) groups. Further subgrouping according to presence or absence of cryoglobulins (Cgs) was done. The battery of investigations included platelet count, estimation of prothrombin INR, HCV RNA, Cgs, Autoantibodies Namely Antinuclear (ANA), anti-smooth muscle (ASMA) and antimitochondrial (AMA), markers of complement (c) activation (C3, C4, C3d), immunoglobulins (Ig) G and M, in addition to flow cytometry for B-cell separation and detection of CD81 and CD5 positive cells. We came to the conclusion that HCV patients on HD had lower viremia levels and more impaired immune status than those with normal renal function. CG when present manipulated the immune system further and was correlated to most of the immunological (RF, autoantibodies, C4, C3d and IgM) and hematological (platelets and INR) markers. Overexpression of CD81 and CD5 was observed particulary in Cg positive cases, thus necessitating follow-up for fear of potential lymphotransformation.