title: Acquired aplastic anaemia in seven children with severe hepatitis with or without liver failure.
abstract: OBJECTIVE
  Aplastic anaemia following hepatitis may develop in as many as 1 of 3 patients with non-A, non-B and non-C hepatitis. Several causative factors have been discussed, such as viral infections and autoimmunity. Here we describe the natural history of this condition in 7 children and investigate possible hepatitis-causing agents.
  
  
  METHODS
  We reviewed the medical records, bone marrow and liver biopsies of 7 children with severe hepatitis, with or without liver failure, who subsequently had developed aplastic anaemia.
  
  
  RESULTS
  The median time from onset of hepatic symptoms until diagnosed onset of aplasia was 54 days. No associated viral infections could be identified. On liver biopsy, a majority had lobular inflammation but lacked signs of autoimmune hepatitis, findings compatible with a viral aetiology. Three of 6 children had low reticulocyte counts already at onset of hepatitis. All, but one patient is alive at median follow-up of 8 years.
  
  
  CONCLUSIONS
  The unknown pathogenetic mechanism appears to target liver and bone marrow simultaneously, because half of the children concomitantly had low reticulocyte counts and severe liver failure.
authors: Department of Paediatrics, Karolinska University Hospital, Huddinge, Clintec, Karolinska Institutet, S-141 86 Stockholm, Sweden. emma.honkaniemi@karolinska.se
authors: Emma
authors: E
authors: Honkaniemi
authors: Britt
authors: B
authors: Gustafsson
authors: Björn
authors: B
authors: Fischler
authors: Antal
authors: A
authors: Nemeth
authors: Britt-Marie
authors: BM
authors: Frost
authors: Nikos
authors: N
authors: Papadogiannakis
authors: Jacek
authors: J
authors: Winiarski
mesh_terms: D000293:Adolescent; D000741:Anemia, Aplastic / Q000209:etiology* / Q000628:therapy; D001706:Biopsy; D001854:Bone Marrow Cells / Q000473:pathology; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006505:Hepatitis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000209:etiology*; D008297:Male; D008499:Medical Records; D017992:Parvovirus / Q000472:pathogenicity; D012189:Retrospective Studies; D012698:Serologic Tests; D013548:Sweden; D013997:Time Factors