1
|
Hepatitis-associated Aplastic Anemia. J Pediatr Gastroenterol Nutr 2022; 75:553-555. [PMID: 36070526 DOI: 10.1097/mpg.0000000000003603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hepatitis-associated aplastic anemia (HAAA) accounts for 4% of autoimmune hepatitis in children. An episode of seronegative autoimmune hepatitis is followed a few days or months later by aplastic anemia or full aplasia. This autoimmune disease could be due to a regulation defect in the immune response to a viral trigger, in a genetically predisposed individual. Other causes of hepatitis or aplastic anemia have to be ruled out. Steroids and azathioprine usually control the liver damage but do not prevent the development of aplastic anemia. Aplastic anemia is treated with either hematopoietic stem cell transplantation in patients with a sibling donor or anti-thymocyte globulins and cyclosporine. We propose guidelines to explore and treat this rare disease. We emphasize on the necessary close collaboration between hepatologists and hematologists.
Collapse
|
2
|
Tüfekçi Ö, Özdemir HH, Malbora B, Özbek NY, Yarali N, Erdem A, Evim M, Baytan B, Güneş AM, Karapinar T, Oymak Y, Töret E, Bör Ö, Yilmaz Ş, Ören H, Özdemir GN, Karapinar DY. Hepatitis-Associated Aplastic Anemia: Etiology, Clinical Characteristics and Outcome. J Pediatr Hematol Oncol 2022; 44:e223-e226. [PMID: 34669357 DOI: 10.1097/mph.0000000000002268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022]
Abstract
Hepatitis-associated aplastic anemia (HAA) is a form of acquired aplastic anemia (AA) in which bone marrow failure develops after an acute attack of hepatitis. Bone marrow failure leading to AA is generally severe in cases of HAA and fatal if left untreated. This retrospective multicenter study investigated clinical and laboratory characteristics, possible causes, treatment, and outcome of HAA in children. Twenty patients from 8 centers were included in the study. Aspartate aminotransferase and alanine aminotransferase were <3 to 5×upper limit of normal (ULN) in 2 patients, <5 to 10×ULN in 2 patients, and >10×ULN in 16 patients. Acute liver failure developed in 5 (29%) patients. Pancytopenia was simultaneously present in 6 of 20 (30%) patients. Eleven of the 20 patients (55%) were alive, in remission and transfusion free. Those who were alive either had undergone hematopoietic stem cell transplantation and/or immunosuppressive treatment, except 1 patient who had received no treatment. Patients with the diagnosis of acute hepatitis should be evaluated and followed up carefully for presence of cytopenia, so that definitive treatment of AA can be initiated in a timely and appropriate manner when needed.
Collapse
Affiliation(s)
- Özlem Tüfekçi
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine
| | - Hamiyet H Özdemir
- Department of Pediatric Hematology, Ege University Faculty of Medicine
| | - Bariş Malbora
- Department of Pediatric Hematology/Oncology, Ankara City Hospital, The University of Health Sciences, Ankara
| | - Namik Y Özbek
- Department of Pediatric Hematology/Oncology, Ankara City Hospital, The University of Health Sciences, Ankara
| | - Neşe Yarali
- Department of Pediatric Hematology/Oncology, Ankara City Hospital, The University of Health Sciences, Ankara
| | - Arzu Erdem
- Department of Pediatric Hematology/Oncology, Ankara City Hospital, The University of Health Sciences, Ankara
| | - Melike Evim
- Department of Pediatric Hematology, Uludağ University Faculty of Medicine, Bursa
| | - Birol Baytan
- Department of Pediatric Hematology, Uludağ University Faculty of Medicine, Bursa
| | - Adalet M Güneş
- Department of Pediatric Hematology, Uludağ University Faculty of Medicine, Bursa
| | - Tuba Karapinar
- Department of Pediatric Hematology/Oncology, İstinye University Faculty of Medicine, İstanbul, Turkey
| | - Yeşim Oymak
- Department of Pediatric Hematology/Oncology, İstinye University Faculty of Medicine, İstanbul, Turkey
| | - Ersin Töret
- Department of Pediatric Hematology, Osmangazi University Faculty of Medicine, Eskişehir
| | - Özcan Bör
- Department of Pediatric Hematology, Osmangazi University Faculty of Medicine, Eskişehir
| | - Şebnem Yilmaz
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine
| | - Hale Ören
- Department of Pediatric Hematology, Dokuz Eylül University Faculty of Medicine
| | - Gül N Özdemir
- Department of Pediatric Hematology/Oncology, İstinye University Faculty of Medicine, İstanbul, Turkey
| | - Deniz Y Karapinar
- Department of Pediatric Hematology, Ege University Faculty of Medicine
| |
Collapse
|
3
|
Wang WH, Wu JF, Chang HH, Lu MY, Yang YL, Chou SW, Lin DT, Lin KH, Jou ST. The Impact of Hepatitis on Clinical Outcomes for Pediatric Patients with Aplastic Anemia. J Pediatr 2020; 227:87-93.e2. [PMID: 32805258 DOI: 10.1016/j.jpeds.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/24/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess the prognostic role of hepatitis in pediatric patients with aplastic anemia and the incidence of hepatitis B among patients with hepatitis-associated aplastic anemia in an area with a previously high prevalence of hepatitis B after nationwide hepatitis B vaccination for 30 years. STUDY DESIGN Pediatric patients (n = 78) with aplastic anemia were enrolled in this study, including 9 with hepatitis-associated aplastic anemia. We collected the clinical characteristics, etiologies of the aplastic anemia, hepatitis B virus serology and serum hepatitis B viral load, response to the treatments, and survival outcome from the participants. We applied univariate and multivariate Cox regression analysis to evaluate the correlations between clinical features and survival outcome. Survival analysis was done using Cox regression model and Kaplan-Meier curves. RESULTS Patients with hepatitis-associated aplastic anemia were related to significantly worse survival prognosis when compared with patients with non-hepatitis-associated aplastic anemia, and hepatitis-associated aplastic anemia was the only independent prognostic factor to predict a poor survival outcome in our patients with aplastic anemia by multivariable analysis. In none of the total 78 patients was aplastic anemia related to hepatitis B virus infection. CONCLUSIONS Patients with hepatitis-associated aplastic anemia had a significantly worse prognosis when compared with patients whose aplastic anemia was not hepatitis-associated. This study demonstrates the potential benefit of hepatitis B vaccination in decreasing the incidence of hepatitis-associated aplastic anemia in children.
Collapse
Affiliation(s)
- Wei-Hao Wang
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan
| | - Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiu-Hao Chang
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Meng-Yao Lu
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Li Yang
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shu-Wei Chou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Dong-Tsamn Lin
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kai-Hsin Lin
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shiann-Tarng Jou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|