Meena Mahadev, Meena Durga Shankar, Kumar Deepak, Pandit Sonu
Department of Internal Medicine, All India Institute of Medical Sciences, Bhopal, India.
Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India.
Cardiovasc Hematol Disord Drug Targets. 2022;22(1):6-9. doi: 10.2174/1871529X22666220418105506.
Haematological manifestations in Hepatitis C virus (HCV) infection have been uncommon since the advent of direct-acting antiviral drugs (DAAs). However, primary HCV infection can cause significant haematological disease in the form of various autoimmune cytopenias.
We herein discuss a 68-years-old female with chronic HCV infection for the last 15 years (not on the treatment), who presented with complaints of progressive fatigue, exertional dyspnea, and increased abdominal distention over the previous 20 days. Coombs-positive autoimmune haemolytic anaemia (AIHA) was diagnosed based on the haematological evaluation (raised lactate dehydrogenase, indirect bilirubinemia, raised reticulocyte count and direct Coombs positive). The patient showed significant improvement in haematological indices with oral prednisolone. However, she eventually succumbed to her illness due to underlying decompensated liver disease. HCV infection may associate with global derangement of the immune system, which is likely to cause AIHA. Diagnosis of autoimmune cytopenias can be easily missed in HCV positive patients due to underlying decompensated liver disease and portal hypertension.
Thus, screening of HCV infection is imperative in every patient of AIHA, especially with the high worldwide prevalence of HCV.
自直接作用抗病毒药物（DAA）问世以来，丙型肝炎病毒（HCV）感染中的血液学表现已不常见。然而，原发性HCV感染可导致各种自身免疫性血细胞减少形式的严重血液学疾病。
我们在此讨论一名68岁女性，她在过去15年中患有慢性HCV感染（未接受治疗），在过去20天里出现进行性疲劳、劳力性呼吸困难和腹胀加重的症状。根据血液学评估（乳酸脱氢酶升高、间接胆红素血症、网织红细胞计数升高和直接抗人球蛋白试验阳性）诊断为抗人球蛋白试验阳性的自身免疫性溶血性贫血（AIHA）。患者口服泼尼松龙后血液学指标有显著改善。然而，由于潜在的失代偿性肝病，她最终因病死亡。HCV感染可能与免疫系统的整体紊乱有关，这很可能导致AIHA。由于潜在的失代偿性肝病和门静脉高压，HCV阳性患者中自身免疫性血细胞减少的诊断很容易被漏诊。
因此，对于每一位AIHA患者，尤其是在全球HCV患病率较高的情况下，筛查HCV感染势在必行。
