Koiso Hiromi, Kobayashi Satsuki, Ueki Kazue, Hamada Tetsuya, Tsukamoto Norifumi, Karasawa Masamitsu, Murakami Hirokazu, Nojima Yoshihisa
Medicine and Clinical Science, Gunma University Graduate School of Medicine, Japan.
Rinsho Ketsueki. 2009 May;50(5):424-9.
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.
报告了一例罕见的急性甲型肝炎合并自身免疫性溶血性贫血（AIHA）和纯红细胞再生障碍性贫血（PRCA）的病例。一名55岁女性因类似普通感冒的症状就医，于2007年1月转诊至我院。实验室检查结果显示血清转氨酶和总胆红素水平显著升高（AST 9605 IU/l，ALT 5546 IU/l，T-bil 4.14 mg/dl），凝血酶原时间延长，提示有进展为暴发性肝炎的风险，在入院的第一天和第二天对其进行了血浆置换和血液透析滤过治疗。根据血清IgM抗甲型肝炎病毒升高，诊断为严重急性甲型肝炎。在住院第20天，尽管转氨酶水平有所改善且无任何胃肠道出血迹象，但她的血红蛋白水平开始下降。检测到胆红素和乳酸脱氢酶升高、触珠蛋白降低以及直接抗人球蛋白试验阳性，这些结果提示合并AIHA；然而，网织红细胞计数减少，骨髓显示明显的红系造血低下，因此诊断为PRCA并存。口服泼尼松龙（1 mg/kg/天）后，她的溶血性贫血迅速改善。
