Author’s reply to comment on article: Atypical manifestations of acute viral hepatitis A in children in Bangladesh: Are these really uncommon?

Abstract

2022Dear Editor,We would like to share our ideas on the publication "Atypical manifestations of acute viral hepatitis A in children in Bangladesh: Are these really uncommon?" [1]. We concluded that atypical manifestations such as prolonged cholestasis and ascites are not uncommon in children with acute viral hepatitis A (AVH-A) in developing countries and seen in almost one-sixth of patients [1]. We also agree that the mentioned problems on cholestasis are not uncommon and might be a common problem in patients in many settings as it might be a result of a concurrent disorder like hemolysis [2]. Hemolysis might have been induced by the hepatitis A virus or due to pre-existing hemoglobinopathies [2][3][4]. For this reason, we went for complete blood count with peripheral blood film to find out any evidence of hemolysis. Intravenous hemolysis was defined as a fall of the hemoglobin level with evidence of hemolysis on peripheral blood film and/or increased reticulocyte count. In this subset of patients, a Coombs' test and an osmotic fragility test were done, and anti-nuclear antibody (ANA), glucose-6-phosphatase dehy-drogenase (G6PD), and serum ceruloplasmin levels were determined to screen the etiology of hemolysis. As we considered all possible etiologies of hemolysis and excluded these as contributors for prolonged cholestasis in our study population, we came to the abovementioned conclusion. DeclarationsConflict of interest RA and MB declare no competing interests.Disclaimer The authors are solely responsible for the data and the contents of the paper. In no way are the honorary editor in chief, editorial board members, the Indian Society of Gastroenterology or the printer/ publishers responsible for the results/findings and content of this article.