Elevated serum transaminase values during therapy for acute lymphoblastic leukemia correlate with prior blood transfusions

Fifty‐nine Children treated with acute lymphoblastic leukemia (ALL) were evaluated for abnormalities of liver function in order to monitor chemotherapy‐induced hepatotoxicity. Twenty‐one patients (36%) had elevations of alanine aminotransferase (ALT) in a pattern consistent with either drug‐induced hepatocellular injury or non‐A, non‐B (NANB) hepatitis. These 21 patients (Group 1) were compared with the other 38 children (Group 2) with regard to a number of clinical and laboratory characteristics. Patients in Group 1 were older (P = 0.002) and had lower platelet counts (P < 0.001) and hemoglobin values (P = 0.075) at diagnosis than Group 2 patients. The median number of units of blood products transfused was significantly greater in Group 1 patients (9.0 versus 1.0 units, P < 0.001). The two groups were similar with regard to chemotherapy regimens. Children with ALL who present at an older age and who have more marked anemia and thrombocytopenia require more blood transfusions and are more likely to develop elevated ALT values in a pattern consistent with acute or chronic NANB hepatitis. These findings suggest a predominant role of NANB posttransfusion hepatitis—rather than or in addition to chemotherapy induced hepatic injury—as a cause for elevated ALT values in children with ALL. In view of the potentially serious consequences of NANB hepatitis, a change in transfusion support practices may be warranted.