title: Aplastic anemia and viral hepatitis. Non-A, Non-B, Non-C?
abstract: OBJECTIVE
  To test the hypothesis that the rare, often fatal, syndrome of hepatitis-associated aplasia is associated with hepatitis C virus infection.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary referral centers in the United States, Japan, Italy, and Germany.
  
  
  METHODS
  Twenty-eight patients with onset of aplastic anemia within 90 days after seeking medical attention for jaundice, or having serum transaminase levels 150% or more of normal (hepatitis-associated aplasia patients) and three patients who developed aplastic anemia following liver transplantation for non-A, non-B hepatitis.
  
  
  METHODS
  Presence of hepatitis C in serum, bone marrow, and liver samples, detected by the polymerase chain reaction; antibody testing; and percentage of activated peripheral cytotoxic T lymphocytes determined by immunophenotyping.
  
  
  RESULTS
  Hepatitis ribonucleic acid was present in the serum samples of 10 (36%) patients with hepatitis-associated aplasia. However, hepatitis C virus viremia was associated with transfusions received after the onset of aplasia: seven (58%) of 12 patients with hepatitis-associated aplasia who had received 21 or more units of blood products at the time of serum sampling were viremic, compared with only three (19%) of 16 patients with hepatitis-associated aplasia who had received 20 or less units of blood products (P less than .05). Hepatitis C virus was not found in blood and bone marrow samples of three National Institutes of Health case patients tested at the time of diagnosis. None of three livers from non-A, non-B hepatitis patients who developed aplastic anemia after liver transplantation contained hepatitis C virus ribonucleic acid. Activated CD8+ T lymphocytes were elevated three- to 20-fold early in the course of hepatitis-associated aplasia.
  
  
  CONCLUSIONS
  Our results implicate a novel, non-A, non-B, and non-C agent in both hepatitis-associated aplasia and fulminant hepatitis.
authors.affiliation: Clinical Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, Md 20892.
authors.forename: J R
authors.initials: JR
authors.lastname: Hibbs
authors.forename: N
authors.initials: N
authors.lastname: Frickhofen
authors.forename: S J
authors.initials: SJ
authors.lastname: Rosenfeld
authors.forename: S M
authors.initials: SM
authors.lastname: Feinstone
authors.forename: S
authors.initials: S
authors.lastname: Kojima
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: A
authors.initials: A
authors.lastname: Locasciulli
authors.forename: A G
authors.initials: AG
authors.lastname: Tzakis
authors.forename: H J
authors.initials: HJ
authors.lastname: Alter
authors.forename: N S
authors.initials: NS
authors.lastname: Young
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000032:analysis
chemical_list: D012367:RNA, Viral