3 cases of hepatitis associated aplastic anemia caused by acute hepatitis E

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1 1046 doi /j. issn HAAA HAAA HAAA R574 B cases of hepatitis associated aplastic anemia caused by acute hepatitis E WANG Lijia 1 JIANG Yuyong 1 WANG Peng 2 YU Hao 1 DU Hongbo 1 YANG Zhiyun Department of Traditional Chinese Medicine 2. Department of Pathology Beijing Ditan Hospital Capital Medical University Beijing China Abstract The clinical features and the outcomes of diagnosis and treatment of 3 patients with HAAA who were admitted to hospital from Jan to May were analyzed retrospectively. They were infected with hepatitis E virus in hepatitis convalescence. They were confirmed the diagnosis by bone marrow biopsy due to severe anemia. Two patients were cured. One patient was died because refusing gammaglobulin for personal reasons. HAAA was no prodromal symptoms which occurred in hepatitis recovery so the young male patients with hepatitis virus of unknown cause were needed to monitor blood and bone marrow biopsy. Key words Acute hepatitis E Hepatitis associated aplastic anemia Posthepatitic aplastic anemia Pure red cell aplasia anemia Virus hepatitis hepatitis associated aplastic a- nemia HAAA 1 85% 2 E 200 HAAA 3 27 ALT U /L AST % 3 U /L TBIL 463 μmol /L DBIL 335 μmol /L PTA 121% g /L 4 3 HEV HAAA g /L RE% 0. 09% HAV-IgM - HBsAg - HCV - HEV- IgM - HEV-IgG + WBC /L N% 81% RBC /L Hb 141 g /L PLT /L 121 IU /L ALT 178 IU /L AST 74 IU /L TBIL 136 μmol /L DBIL 117 μmol /L ALB 40 g /L GGT 293 IU /L 1 HE 1 ~ g 6 d 2 u 4 25 ALT U /L AST U / L TBIL μmol /L DBIL μmol /L PTA 110% tianyi1947@ 126. com WBC /L RBC /L Hb g /L PLT yangzhiyun66@ 163. com /L RE% 0. 57%

2 HEV-IgM + ALT U /L AST U /L TBIL μmol / 8 11 L DBIL μmol /L HE HE 200 Fig 1 Bone marrow smears HE staining 200 Erythroid hyperplasia was significantly reduced while granulocytes and megakaryocytes didn t reduced Fig 2 Bone marrow biopsy HE staining 200 Erythroid hypoplasia of bone marrow was low 2 29 HBsAg d 3 d ALT 472 U /L AST 289 U /L TBIL μmol /L DBIL μmol /l ALB g /L GGT 126 U /L CHE 3253 U /L PTA 71. 2% WBC /L N% 50. 5% RBC /L Hb 132 g /L PLT /L -IgM 0. 1% ALT 42 U /L AST 80 U /L TBIL μmol /L - HBsAg + HBeAg + - HDV-IgM HDV-IgG - HEV-IgM + HBV DNA CP /ml AFP ng /ml - Coombs - - Rous WBC /L N% 34. 2% RBC /L Hb 111 g /L PLT /L RE% 1. 8% Bp 0 /0 mmhg HAAA HAAA 6 AA HAAA 10 g 6 d 6 d d ALT 83 U /L AST 198 U /L TBIL μmol /L ALB g /L CHE U /L WBC /L N% 86. 8% RBC /L Hb 108 g /L PLT / L PTA 71. 2% -IgM - HBsAg HBeAg HBcAb - - HDV-IgM HDV-IgG - HEV- IgM WBC /L N% 69. 7% RBC /L Hb 64 g /L PLT /L RE% DBIL 162 μmol /L ALB g /L CHE 1176 U /L PTA 67% + AA 2 ~ allo-hsct / IST 2 ~ 5 AA 12 B19 EB 9 SEN

3 1048 HAAA 2% ~ 5% < /L CD4 + /CD T 150 ~ 250 μg /L 4 ~ 6 INF-γ TNF-β α LT-α 18 CD34 + Fas Fas- Ag Fas-Ag 19 immunosuppressive thempy IST T hematopoietic stem cell transplantation HSCT 4% ~ 10% 13 HAAA % 3. 2% HAAA Th Tc Ⅰ IFN-γ IL-2 TNF-β 83. 7% ~ 87% 57. 1% ~ 5 DNA Gonzalez CR EBMT HAAA HCT IST 1 HAAA 22 supportive care definitive therapy HAAA allo-hsct HAAA 2 T 1 < /L < HAAA Tr 15 CFU-GM BFU-E CFU-E 3 40 Dilloo 16 ATG -6 IL-6 ALG ATG ATG 12 ~ 20 mg / kg d 3 ~ IL-6 mrna IL-6 5 mg / kg d 5 d 2 HAAA ~ 100 mg /d 120 ~ 240 mg /d 6 ~ 12 mg /d CD8 + T CD4 + T CsA 3 ~ 7 mg / kg d 2 CsA -- clonal inhibitory factor CIF /L HAAA CD8 + T CD4 + T CD4 + /CD8 + T HAAA T G-CSF 2 T HLA A CsA % ~ 79 d 51 d < 1% < /L < /L 3

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