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Case Studies | Medicine | India | Volume 14 Issue 2, February 2025 | Rating: 6 / 10
Hepatitis-Associated Aplastic Anemia: A Case Study on Hematopoietic Crisis and Clinical Implications
Dr. Sai Surya Teja B., Dr. Hareeth Reddy R, Dr. Santhosh Gowda VR, Dr. Prudhveer Reddy K., Dr. Krishna Sowmya M.
Abstract: Background: Hepatitis-associated aplastic anemia (HAAA) is a rare but severe condition marked by bone marrow failure following acute hepatitis, often with an unknown aetiology. This study aims to present a rare case of Hepatitis-Associated Aplastic Anemia, outlining its clinical progression, treatment challenges, and potential interventions to improve outcomes. This case study presents a 48-year-old contract labourer who developed HAAA after an episode of seronegative hepatitis. Initial treatment focused on managing liver dysfunction; however, progressive pancytopenia led to a fatal deep neck infection. This report highlights the critical need for early diagnosis, bone marrow transplantation, or immunosuppressive therapy to improve patient outcomes. Case Presentation: A 48-year-old male contract labourer presented with a one-week history of progressive fatigue, jaundice, dark urine, pruritus, and abdominal discomfort. Initial investigations revealed elevated liver enzymes (AST: 778 U/L, ALT: 1317 U/L) and hyperbilirubinemia (TB: 7.66 mg/dL). Serology for hepatitis A, B, C, and E was negative. Imaging demonstrated hepatomegaly with periportal cuffing and a thickened gallbladder wall. He was diagnosed with acute viral hepatitis of unknown etiology and treated with ursodeoxycholic acid, hepatoprotective agents, and antihistamines. At follow-up, the patient presented with new-onset pancytopenia, petechiae, purpura, and fatigue. Bone marrow biopsy revealed hypocellularity (5-10%), confirming severe aplastic anemia. Despite supportive management with transfusions, antibiotics, and antifungal prophylaxis, the patient?s condition deteriorated due to febrile neutropenia and a deep neck infection following a dental procedure. This led to airway obstruction and a fatal outcome. Discussion: HAAA involves immune-mediated destruction of hematopoietic cells, with cytotoxic T-cell activation as a key mechanism. First-line therapy includes allogeneic bone marrow transplantation (BMT) or immunosuppressive therapy (IST) for those without a matched donor. Early diagnosis and intervention are crucial, as delayed treatment and secondary infections are associated with poor prognosis. Conclusion: HAAA should be considered in patients with acute hepatitis and subsequent pancytopenia. Early BMT or IST, along with rigorous infection prevention, is essential to improve outcomes.
Keywords: Hepatitis-associated aplastic anemia, Bone marrow transplantation, Pancytopenia, Cytotoxic T cells, Immunosuppressive therapy
Edition: Volume 14 Issue 2, February 2025,
Pages: 292 - 295