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

1046 doi 10. 3969 /j. issn. 1006-5709. 2013. 10. 031 3 1 1 2 1 1 1 1. 2. 100015 2000 1-2013 5 3 HAAA 3 2 1 HAAA HAAA R574 B 1006-5709 2013 10-1046 - 05 3 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 1 2013-06-13 1. Department of Traditional Chinese Medicine 2. Department of Pathology Beijing Ditan Hospital Capital Medical University Beijing 100015 China Abstract The clinical features and the outcomes of diagnosis and treatment of 3 patients with HAAA who were admitted to hospital from Jan. 2000 to May. 2013 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 46. 1 U /L AST 48. 7 2. 2% 3 U /L TBIL 463 μmol /L DBIL 335 μmol /L PTA 121% - 4-9 4 17 70. 4 g /L 4 3 HEV HAAA 10-11 18 55. 2 g /L RE% 0. 09% 2000 1-2013 5 3 1 46 2 2012 3 12 HAV-IgM - HBsAg - HCV - HEV- IgM - HEV-IgG + WBC 9. 06 10 9 /L N% 81% RBC 4. 65 10 12 /L Hb 141 g /L PLT 206 10 9 /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 ~ 3 2 125 10 g 6 d 2 u 4 25 ALT 67. 7 U /L AST 57. 2 U / L TBIL 330. 4 μmol /L DBIL 244. 5 μmol /L PTA 110% E-mail tianyi1947@ 126. com WBC 6. 01 10 9 /L RBC 2. 6 10 9 /L Hb 80. 1 g /L PLT E-mail yangzhiyun66@ 163. com 273. 4 10 9 /L RE% 0. 57%

1047 5 25 HEV-IgM + ALT 61. 3 U /L AST 55. 3 U /L TBIL 19. 4 μmol / 8 11 L DBIL 14. 0 μmol /L 1 3 1 HE 200 2 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 + 15 12 d 3 d 2004 11 5 1 2 3 4 ALT 472 U /L AST 289 U /L TBIL 219. 4 μmol /L DBIL 154. 2 μmol /l ALB 40. 6 g /L GGT 126 U /L CHE 3253 U /L PTA 71. 2% WBC 2. 9 10 9 /L N% 50. 5% RBC 3. 47 10 12 /L Hb 132 g /L PLT 19 10 9 /L -IgM 0. 1% ALT 42 U /L AST 80 U /L TBIL 262. 7 μmol /L - HBsAg + HBeAg + - HDV-IgM HDV-IgG - HEV-IgM + HBV DNA 2. 27 10 7 CP /ml AFP 38. 3 ng /ml - Coombs - - Rous + 11 13 WBC 2. 37 10 9 /L N% 34. 2% RBC 3. 03 10 12 /L Hb 111 g /L PLT 12 10 9 /L 11 15 RE% 1. 8% 2003 9 16 Bp 0 /0 mmhg HAAA HAAA 6 AA HAAA 10 g 6 d 6 d 10 3 72 2 10 d 2003 8 21 ALT 83 U /L AST 198 U /L TBIL 22. 22 μmol /L ALB 26. 4 g /L CHE 2 284 U /L WBC 11. 8 10 9 /L N% 86. 8% RBC 2. 94 10 12 /L Hb 108 g /L PLT 141 10 9 / L PTA 71. 2% -IgM - HBsAg HBeAg HBcAb - - HDV-IgM HDV-IgG - HEV- IgM + - - + 2003 9 8 WBC 1. 15 10 9 /L N% 69. 7% RBC 1. 79 10 12 /L Hb 64 g /L PLT 59 10 9 /L RE% DBIL 162 μmol /L ALB 22. 6 g /L CHE 1176 U /L PTA 67% + AA 2 ~ 4 1 11 allo-hsct / IST 2 ~ 5 AA 12 B19 EB 9 SEN

1048 HAAA 2% ~ 5% < 20 10 9 /L CD4 + /CD8 + 17 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 2 0. 033% 3. 2% HAAA Th Tc Ⅰ IFN-γ IL-2 TNF-β 83. 7% ~ 87% 57. 1% 21 1 20 11 2 ~ 5 DNA Gonzalez CR 7 2010 EBMT HAAA HCT 1955 13 IST 1 HAAA 22 supportive care definitive therapy HAAA allo-hsct HAAA 2 T 1 < 10 10 9 /L < 14 13 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 22 4 16 50 ~ 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 20 10 9 /L HAAA CD8 + T CD4 + T CD4 + /CD8 + T HAAA T G-CSF 2 T HLA A CsA 3 1 49 66. 7% 10 22 ~ 79 d 51 d 20 3 2 < 1% < 15 10 6 /L < 0. 5 10 9 /L 3

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