Chonnam Med J.  2011 Apr;47(1):51-53. 10.4068/cmj.2011.47.1.51.

Pure Red Cell Aplasia Caused by Acute Hepatitis A

• Lee TH
• Oh SJ
• Hong S
• Lee KB
• Park H
• Woo HY

• KMID: 2172247
• DOI: http://doi.org/10.4068/cmj.2011.47.1.51

Abstract

Pure red cell aplasia is characterized as a normocytic anemia associated with reticulocytopenia and the absence of erythroblasts in the bone marrow. Pure red cell aplasia can be induced by various causes such as thymoma, connective tissue disease, viral infection, lymphoma, and adverse drug reactions. There have been only a few reports of pure red cell aplasia associated with acute viral hepatitis A. In Korea, no case of pure red cell aplasia caused by acute hepatitis A has yet been reported. We recently experienced a case of acute viral hepatitis A complicated by pure red cell aplasia. The patient was successfully treated with corticosteroids. Here we report this case and review the literature.

Keyword

Red-cell aplasia; Hepatitis A; Acute Kidney injury

MeSH Terms

Acute Kidney Injury
Adrenal Cortex Hormones
Anemia
Bone Marrow
Connective Tissue Diseases
Drug Toxicity
Erythroblasts
Hepatitis
Hepatitis A
Humans
Korea
Lymphoma
Red-Cell Aplasia, Pure
Thymoma
Adrenal Cortex Hormones

Figure

• 

  FIG. 1 Bone marrow biopsy section showing normocelluar marrow with marked erythroid hypoplasia (×200, H&E stain).

• 

  FIG. 2 Bone marrow aspirates showing a paucity of erythroid precursors with normal granulocytes and megakaryocytes. (A) (×200, Wright-Geimsa stain). (B) (×400, Wright-Geimsa stain) arrow: basophilic normoblast.

• 

  FIG. 3 The time course of the hemoglobin, reticulocyte count, and serum creatinine.

Reference

1. Fisch P, Handgretinger R, Schaefer HE. Pure red cell aplasia. Br J Haematol. 2000. 111:1010–1022.

2. Koiso H, Kobayashi S, Ueki K, Hamada T, Tsukamoto N, Karasawa M, et al. Pure red cell aplasia accompanied by autoimmune hemolytic anemia in a patient with type A viral hepatitis. Rinsho Ketsueki. 2009. 50:424–429.

3. Della Loggia P, Cremonini L. Acute hepatitis-associated pure red cell aplasia: a case report. Infez Med. 2002. 10:236–238.

4. Chehal A, Sharara AI, Haidar HA, Haidar J, Bazarbachi A. Acute viral hepatitis A and parvovirus B19 infections complicated by pure red cell aplasia and autoimmune hemolytic anemia. J Hepatol. 2002. 37:163–165.

5. Tomida S, Matsuzaki Y, Nishi M, Ikegami T, Chiba T, Abei M, et al. Severe acute hepatitis A associated with acute pure red cell aplasia. J Gastroenterol. 1996. 31:612–617.

6. Simmons J, Stein L, Kaufman A. Pure red cell aplasia and hepatitis A. South Med J. 1993. 86:1274–1276.

7. Sawada K, Hirokawa M, Fujishima N. Diagnosis and management of acquired pure red cell aplasia. Hematol Oncol Clin North Am. 2009. 23:249–259.

8. Clark DA, Dessypris EN, Krantz SB. Studies on pure red cell aplasia. XI. Results of immunosuppressive treatment of 37 patients. Blood. 1984. 63:277–286.

9. Raghavachar A. Pure red cell aplasia: review of treatment and proposal for a treatment strategy. Blut. 1990. 61:47–51.