Etiology of hemolysis in two patients with hepatitis A infection: glucose-6-phosphate dehydrogenase deficiency or autoimmune hemolytic anemia

Abstract

We report two children with hemolytic anemia during the course of hepatitis A infection. On admission, the patients had high blood urea nitrogen, creatinine, and uric acid levels, as well as anemia, leucocytosis, and direct and indirect hyperbilirubinemia. Both patients had a glucose-6-phosphate dehydrogenase deficiency (G6PD) and autoimmune antibodies. They were given vitamin K on admission. Inadvertent administration of vitamin K could have been related to an acute reduction in hemoglobin concentration. To prevent renal damage, plasmapheresis with fresh frozen plasma was done to clear bilirubin and plasma hemoglobin. The hyperbilirubinemia responded to plasmapheresis. However, acute tubular necrosis complicated the clinical course in one patient, and several sessions of hemodialysis were required. In conclusion, intravascular hemolysis should be considered in patients with hepatitis A infection, marked hyperbilirubinemia, and anemia. Although hepatitis A vaccination is not yet recommended for routine administration, high-risk patients, including those with a G6PD deficiency, should be vaccinated against hepatitis A.

Hemolysis and methemoglobinemia due to hepatitis E virus infection in patient with G6PD deficiency

“…The pathogenetic link between viral hepatitis and oxidative hemolysis is unclear, and hemolysis can occur in non-G6PD deficient patients [2]. Hence, in some cases, antibody or complement-mediated mechanisms are involved [5, 6]. In our patient, however, the methemoglobulinemia strongly suggest oxidative stress to the G6PD-deficient erythrocytes.…”

“…Hence, in Far East countries, where G6PD deficiency and raw food consumption are both common, such a clinical picture should be recognized. Proper preventive measures (e.g., vaccination and better hygiene) would also be prudent for health officials and susceptible individuals [5]. …”

The Redox Role of G6PD in Cell Growth, Cell Death, and Cancer

“…Microbial infection in G6PD-deficient patients is mainly related to hemolytic anemia caused by plasmodia or viruses [132,133,134,135]. Lack of G6PD activity is a risk factor for neonatal sepsis in males [108].…”

Hepatitis A Virus-induced Severe Hemolysis Complicated by Severe Glucose-6-Phosphate Dehydrogenase Deficiency

“…Plasmapheresis has also been used previously in patients with hepatitis A infection with G6PD deficiency in the background of autoimmune hemolysis, with good results. [ 17 ] However, ours is the first report of using hemodialysis with hemoperfusion in such patients.…”