Etiology of hemolysis in two patients with hepatitis A infection: glucose-6-phosphate dehydrogenase deficiency or autoimmune hemolytic anemia.
We report two children with hemolytic anemia during the course of hepatitis A infection. On admission, the patients had high blood urea nitrogen, creatinine, and uric acid levels, as well as anemia, leucocytosis, and direct and indirect hyperbilirubinemia. Both patients had a glucose-6-phosphate dehydrogenase deficiency (G6PD) and autoimmune antibodies. They were given vitamin K on admission. Inadvertent administration of vitamin K could have been related to an acute reduction in hemoglobin concentration. To prevent renal damage, plasmapheresis with fresh frozen plasma was done to clear bilirubin and plasma hemoglobin. The hyperbilirubinemia responded to plasmapheresis. However, acute tubular necrosis complicated the clinical course in one patient, and several sessions of hemodialysis were required. In conclusion, intravascular hemolysis should be considered in patients with hepatitis A infection, marked hyperbilirubinemia, and anemia. Although hepatitis A vaccination is not yet recommended for routine administration, high-risk patients, including those with a G6PD deficiency, should be vaccinated against hepatitis A.
Ozbay Hosnut
Ferda
F
Pediatric Gastroenterology, Hepatology and Nutrition, Başkent University Faculty of Medicine, Ankara, Turkey. ferdaozbay72@yahoo.com
Ozcay
Figen
F
Selda Bayrakci
Umut
U
Avci
Zekai
Z
Ozbek
Namik
N
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005954:Glucosephosphate Dehydrogenase / Q000235:genetics; D005955:Glucosephosphate Dehydrogenase Deficiency / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006461:Hemolysis; D006506:Hepatitis A / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D017957:Hepatitis A Virus, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D010956:Plasmapheresis; D006435:Renal Dialysis; D016896:Treatment Outcome
D005954:Glucosephosphate Dehydrogenase