title: Pure red cell aplasia accompanied by autoimmune hemolytic anemia in a patient with type A viral hepatitis.
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.
authors.affiliation: Medicine and Clinical Science, Gunma University Graduate School of Medicine, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Koiso
authors.forename: Satsuki
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Kazue
authors.initials: K
authors.lastname: Ueki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hamada
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsukamoto
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Karasawa
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Murakami
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nojima
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006506:Hepatitis A / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D010956:Plasmapheresis; D011239:Prednisolone / Q000008:administration & dosage; D012010:Red-Cell Aplasia, Pure / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006435:Renal Dialysis; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D011239:Prednisolone