Abstract
Primary autoimmune hemolytic anemia (AIHA) with leukemoid reaction is a rare extrahepatic manifestation of chronic hepatitis C virus (HCV) infection. However this can be successfully treated with prednisone therapy and does not form a contraindication to antiviral treatment. Hence, we report a case of direct Coombs’-positive AIHA with leukemoid reaction in treatment-naive 35-year-old Indian female with past medical history of chronic hepatitis C, genotype 1 who was successfully treated with prednisone therapy followed by pegylated interferon [PEG-IFN alfa-2a (180 μg/week)] plus ribavirin [RBV (1000 mg/day)] for 48 weeks. On follow up visit she had neither HCV infection nor AIHA.
Keywords: autoimmune hemolytic anemia (AIHA ), chronic hepatitis C.
References
- Takase K, Nakano T, Hamada M, Shiraki K, Oohashi Y, Kihira T et al. Hemolytic anemia provoked by recombinant alpha-interferon. J Gastroenterol 1995:30: 795–797.
- de-la-Serna-Higuera C, Barcena-Marugan R, sanz-de- Villalobos E. Hemolytic anemia secondary to alpha-interferon treatment in a patient with chronic C hepatitis. J Clin Gastroenterol 1999: 28: 358–359.
- Greer JP. Wintrobe’s Clinical Hematology. Philadelphia:Lippincott 1998: Vol II:959–961.
- Ji Q, Perchellet A, Goverman JM. Viral infection triggers central nervous system autoimmunity via activation of CD8(?) T cellsexpressing dual TCRs. Nat Immunol 2010: 11:628–34.
- Panush RS, Wilkinson LS, Fagin RR. Chronic active hepatitis associated with eosinophilia and Coombs'-positive hemolytic anemia. Gastroenterology 1973: 64(5):1015-9.
- Gastroenterol, Srinivasan R. Autoimmune hemolytic anemia in treatment-naïve chronic hepatitis C infection. J Clin 2001:32(3):245-7.
- Cauli C, Serra G, Chessa L, Balestrieri C, Scioscia R, Lai ME, et al. Severe autoimmune hemolytic anemia in a patient with chronic hepatitis C during treatment with peginterferon alfa-2a and ribavirin. Haematologica 2006: Suppl:ECR26, 91(6).
- Ramos-Casals M, Garcia-Carrasco M, Lopez-Medrano F, Trejo O, Forns X, Lopez-Guillermo A et al. Severeautoimmune cytopenias in treatment-naive hepatitis C virus infection. Clinical description of 35 cases. Medicine 2003 :82: 87–96.
- Abramson N, Melton B. Leukocytosis: Basics of Clinical Assessment: Am Fa Physician 2000:62(9):2053-2060.
- McHutchison JG, Manns MP, Longo DL. Definition and management of anemia in patients infected with hepatitis C virus. Liver Int 2006:26:389-98.
Corresponding Author
Pratibha Prasad
M.D. Gen Medicine, Department of General Medicine, Institute of Medical Science ,
Banaras Hindu University, Varanasi – 221005, Uttar Pradesh, India
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