A case of acute hepatitis associated with severe hemolytic anemia

A 21-year-old female, had experienced skin eruption for one month, was admitted to a clinic with general fatigue, anorexia, nausea and jaundice. Two weeks after the peak of transaminase levels, high fever and wine colored urine were recognized and serum hemoglobin concentration decreased to 2.0 g/dl. Then, she was received blood transfusions and refered to our hospital. Acute viral hepatitis type non-A, non-B was most suspected because of negative IgM-antiHA, HBs antigen and IgM-antiHBc. Laboratory examinations disclosed severe anemia, reticulocytosis, marked elevation of LDH (LDH1: 37.3%) and marked decrease of haptoglobin, but negative direct Coombs test. Bone marrow showed erythroid hyperplasia. From these findings, the diagnosis of hemolytic anemia was made. She recovered with conservative therapy alone. We reviewed similar cases reported inJapan and discussed some mechanisms of the hemolysis.