Hereditary/Acquired Bleeding Disorders

While hepatocellular carcinoma (HCC) acquired through blood transfusion is the leading cause of liver disease in hemophilia, there are few data on HCC in the hemophilia population in the current era of direct-acting antiviral (DAA) therapy. At the 63rd Annual Meeting of the American Society of Hematology (ASH), investigators from the University of Pittsburgh Medical Center and the Hemophilia Center of Western Pennsylvania, Pittsburgh, reported on a large observational study (abstract 593) including 7,674,969 adult male discharges in the National Inpatient Sample (NIS) database between 2016 and 2018. During that time period, there were 3,370 males with hemophilia (.04%) in this population. Diagnosis rates of hepatitis C virus (HCV) and HCC were similar for those with vs without hemophilia, but compared with HCC patients in the NIS database without hemophilia, males with hemophilia and HCC were older (58.6 vs 50.9 years-old, P<.001); had a higher Charlson comorbidity index (P<.001); and had higher prevalences of HCV (36.11% vs 9.78%), hepatitis B virus (11.11% vs 0.45%), nonalcoholic steatohepatitis (NASH; 5.56% vs 0.12%), end-stage liver disease (88.89% vs 8.61%), portal hypertension (27.78% vs 2.61%), and platelet transfusion (11.11% vs 1.44%). The prevalence of HIV infection in males with hemophilia with vs without HCC was similar (8.33% vs 8.82%). Multivariable logistic regression analysis among males with hemophilia indicated that NASH, infections with HCV, and Charlson comorbidity were significant risk factors for HCC. In contrast, HIV and hyperlipidemia were protective. In conclusion, the investigators wrote, "Chronic HCV infection remains a significant risk factor of HCC in hemophilia despite availability of DAA therapy."