Abstract
Severe non-immune mediated haemolytic anaemia (HA) rarely occurs in acute viral hepatitis, unless patients have underlying red cell enzyme abnormalities or pre-existing liver disease. We report such a case and provide a summary of other available cases to date.Overall, young and fit patients suffering from acute viral hepatitis seem to be affected. Several viral subtypes have been associated, although we report the first hepatitis B and E co-infection case. It seems to occur when patients are recovering from hepatitis and the disease course is variable. The degree of anaemia is always severe, and is inevitably associated with increased morbidity and mortality.Several theories exist with regard to its aetiology, including the disruption of erythrocyte metabolism. Although its optimal treatment strategies remain unclear, some evidence suggests a possible role for steroid therapy.
Highlights
Mild haemolysis is a well known phenomenon associated with acute viral hepatitis and occurs in approximately 4% of affected patients[1], severe non-immune mediated haemolytic anaemia (HA) is rare and is usually associated with underlying red cell enzyme abnormalities[2,3] or pre-existing liver diseases[4,5]
Several viral subtypes have been associated, we report the first hepatitis B and E co-infection case
Background mild haemolysis is a well known phenomenon associated with acute viral hepatitis and occurs in approximately 4% of affected patients[1], severe non-immune mediated haemolytic anaemia (HA) is rare and is usually associated with underlying red cell enzyme abnormalities[2,3] or pre-existing liver diseases[4,5]
Summary
Mild haemolysis is a well known phenomenon associated with acute viral hepatitis and occurs in approximately 4% of affected patients[1], severe non-immune mediated haemolytic anaemia (HA) is rare and is usually associated with underlying red cell enzyme abnormalities[2,3] or pre-existing liver diseases[4,5]. Case report A 48 year old Chinese male manual worker was admitted on 4th February with acute right-upper-quadrant abdominal pain for 5 days, preceded by flu like illness. He had no past history of liver disease, anaemia or bleeding disorders. Deep jaundice and right-upper-quadrant tenderness with no signs of chronic liver disease or hepatic encephalopathy His blood tests showed a severe hepatitis picture (Table 1) including a total bilirubin of 291 μmol/L and alanine transaminase (ALT) of 8320 IU/L. His direct Coombs test was negative with a normal cold agglutinin titre, confirming non-autoimmune haemolytic anaemia He was treated with folate, 5 mg once a day from day 5 to day 9 following admission. The patient failed to improve and succumbed on day 10
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