Autoimmune thrombocytopenia and erythroid hypoplasia associated with hepatitis A

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Other Title
  • 赤芽球低形成と自己免疫機序による血小板減少を合併したA型肝炎
  • 症例 赤芽球低形成と自己免疫機序による血小板減少を合併したA型肝炎
  • ショウレイ セキガキュウ テイケイセイ ト ジコ メンエキ キジョ ニ ヨル ケッショウバン ゲンショウ オ ガッペイ シタ Aガタ カンエン

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Abstract

A 53-year-old woman developed fever and fatigue after eating raw oysters, and consulted a local clinic. She exhibited liver dysfunction and jaundice, and was therefore referred and admitted to our hospital. Hepatitis A was diagnosed based on virus markers, and palliative therapy was administered. After admission, the increased levels of transaminases and lactic acid dehydrogenase (LDH) normalized rapidly. However, marked thrombocytopenia was observed, and steroid pulse therapy was administered. Thereafter, idiopathic anemia developed, and a bone marrow puncture was performed. Bone marrow smears showed marked depletion of cells of the erythroblastic and megakaryocytic series. Parvovirus B19 infection was ruled out, and an additional steroid was administered. However, the patient's anemia and thrombocytopenia persisted. She suffered a prolonged period of cholestasis and died of acute renal failure. At autopsy, the bone marrow revealed severe erythroblastopenia. A diagnosis of thrombocytopenia due to an autoimmune mechanism was made on the basis of elevated levels of platelet-associated immunoglobulin G (PAIgG) and immune complex. Furthermore, the advanced anemia was complicated by concurrent hemolysis. This case may provide information useful for clarifying the pathogenesis of hematopoietic disorders complicated by hepatitis.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 41 (9), 739-744, 2000

    The Japanese Society of Hematology

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