Pure red cell aplasia accompanied by autoimmune hemolytic anemia in a patient with type A viral hepatitis

DOI Web Site 15 References
  • KOISO Hiromi
    Medicine and Clinical Science, Gunma University Graduate School of Medicine Dialysis, Rheumatology and Blood Disease Center, Toho Hospital
  • KOBAYASHI Satsuki
    Dialysis, Rheumatology and Blood Disease Center, Toho Hospital
  • UEKI Kazue
    Dialysis, Rheumatology and Blood Disease Center, Toho Hospital
  • HAMADA Tetsuya
    Department of Internal Medicine, Toho Hospital
  • TSUKAMOTO Norifumi
    Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • KARASAWA Masamitsu
    Blood Transfusion Service, Gunma University Hospital
  • MURAKAMI Hirokazu
    School of Health Sciences, Faculty of Medicine, Gunma University
  • NOJIMA Yoshihisa
    Medicine and Clinical Science, Gunma University Graduate School of Medicine

Bibliographic Information

Other Title
  • A型ウイルス肝炎経過中に自己免疫性溶血性貧血に伴って発症した赤芽球癆
  • 症例報告 A型ウイルス肝炎経過中に自己免疫性溶血性貧血に伴って発症した赤芽球癆
  • ショウレイ ホウコク Aガタ ウイルス カンエン ケイカ チュウ ニ ジコ メンエキセイ ヨウケツセイ ヒンケツ ニ トモナッテ ハッショウ シタ セキガ キュウロウ

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Abstract

A rare case of acute hepatitis A associated with autoimmune hemolytic anemia (AIHA) and pure red cell aplasia (PRCA) is reported. A 55-year-old woman consulted a doctor because of common cold-like symptoms and she was referred to our hospital in January 2007. Laboratory findings showed a marked elevation of serum transaminase and total bilirubin levels (AST 9,605 IU/l, ALT 5,546 IU/l and T-bil 4.14 mg/dl), and prolonged prothrombin time, findings which suggested the risk of progression to fulminant hepatitis, and she was treated with plasmapheresis and hemodialysis filtration on the first and second hospital days. She was diagnosed with severe acute hepatitis A based on the elevation of serum IgM anti-hepatitis A virus. On the 20th hospital day, her hemoglobin level began to decrease in spite of improving transaminase levels without any signs of gastrointestinal bleeding. Bilirubin and LDH elevation, haptoglobin decline and a positive direct Coombs test were detected and these findings indicated AIHA complication; however, the reticulocyte count decreased and bone marrow showed marked erythroid hypoplasia so the co-existence of PRCA was diagnosed. After oral prednisolone administration (1 mg/kg/day), her hemolytic anemia rapidly improved.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 50 (5), 424-429, 2009

    The Japanese Society of Hematology

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