Tohoku
J. exp.
Med.,
1975,
116, 101-102
Short
Viral
Hepatitis
B and
Aplastic
Snozo NAKAMURA, TAKASHI and YASUSHI SATO*
Report
Anemia
SATO,
TOSHIYUKI
MAEDA*
The First Departmentof Internal Medicine, Tohoku University Schoolof Medicine,Sendai, and HikarigaokaSpellmanHospital,* Sendai
NAKAMURA, and
T.,
Aplastic
SATO,
Anemia.
many
cases
nature
of
of
T.,
Tohoku
hepatitis is
not
anemia aplastic
T.
and
Med.,
with
fully
hepatitis-B-antigen-positive
antigen;
exp.
associated
hepatitis
aplastic
MAEDA,
J.
aplastic
A
case
is presented.?
has
acute
viral
hepatitis
Y.
Viral
(1),
There of
viral
116 anemia
understood.
case.
SATO,
1975,
Hepatitis
101-102 •\
have
been
been
so
described, far
no
hepatitis
B;
B
Although
B
hepatitis
the
report
of
developing
B;
hepatitis
B
anemia
Since the association of hepatitis and aplastic anemia was first described by Lorenz and Quaiser (1955), approximately 100 cases of this association have been reported (Camitta et al. 1974). Although some of them belong to the chloramphenicol-hepatitis-aplastic anemia syndrome (Hodgkinson 1973), most of them are believed to have had acute viral hepatitis (Ajlouni and Doeblin 1974; Camitta et al. 1974). In spite of recent advances in detecting hepatitis B surface antigen (HBSAg), however, no HBS-Ag-positive case has been reported. In this paper a case of acute viral hepatitis B developing aplastic anemia is Dresented. A
71-year-old
1974.
One
May
17.
history
He of
physical
was
serum
zinc
phils
65%,
Bone
marrow
anabolic and
consistent
aplastic
lymphocytes
29%,
with
S.G.O.T.
and
weeks
S.G.P.T.
almost
after
to rose
the
for publication,
more
rest,
returned
increased
Hemoglobin
Received
with
Three
albumin
remained
controls,
treated
and
to same.
March
was
jaundice
to
2
normal
g/100ml
Thrombocytes
24, 1975. 101
7.0%, ƒÀ-
7.9
g/100ml,
thrombocytes
very
low
given
blood
red
2,22O/ƒÊ1
and
rate
(neutro 102,000/ƒÊ1.
myeloid
and
months
and ƒÁ-globulin
12.4
Total
of
erythroid
incorporation
236•~103dpm).
subsequently
admission
60.3%
2%),
had
than
test
units.
immunodiffusion.
count
megakaryocytes,
lymphocytes
(5•~103dpm; was
monocytes
sub
alkaline
turbidity
radial
cell
no
and
units,
515
hemoglobin blood
on
admission,
gingiva, 449
thymol
by
April,
was
2.3%, ƒ¿2-globulin
white
decreased
nose,
72,
positive
anemia;
0.5%,
Phytohemagglutinin-stimulated
patient
was
On
dehydrogenase
38.3%, ƒ¿l-globulin
with
hypocellular,
lactic
of admitted
There
S.G.P.T.
index
and
HBSAg
reticulocytes
4%,
was
admission. count
was
eosinophils
steroid.
gradually;
albumin 46.0%.
2,29O,000/ƒÊ1,
3H-thymidine The
g/100ml,
and ƒÁ-globulin
count
elements. of
8.8
units,
the
units,
prothrombin
48
middle was
admission.
from 840
the he
transfusion.
the
bleeding
in and
blood before
S.G.O.T.
units, test
fatigue
appeared,
drugs and
50,
noticed
received
other
was
he
bleeding not
jaundice
turbidity
were
picture
cell
had or
index
until
nasal
and
King-Armstrong
6.4%, blood
health and
revealed
sulphate
proteins
blood
good
abstainer,
Icterus
13.4
globulin
in
jaundice
chloramphenicol
tissue.
units,
The
an
taking
phosphatase
was
later
examination
cutaneous
11.7
male
month
later.
Serum
decreased after
transfusion
HBS-antigenemia
to
6
months,
increased
to
22.0% but
124,000/ƒÊl,
and
an
disappeared, globulin 6
improved months
white
after
blood and
bleeding
cell
102 stopped. slightly
The sternal hvpocellular.
marrow
showed
S. Nakamura
et al.
increases
in erythroid
and myeloid
cells, but remained
Although many cases of hepatitis developing aplastic anemia have been so far reported, the nature of hepatitis is not fully understood. The chloramphenicol-hepatitisaplastic anemia syndrome was proposed rather than viral hepatitis (Hodgkinson 1973). When viral hepatitis was considered, acute viral hepatitis A was suggested since HBSAg was negative in the patients tested (Ajlouni and Doeblin 1974). However, HBSAg was so far examined in only a small number of reported cases (Toda 1973; Ajlouni and Doeblin 1974; Camitta et al. 1974). The anemia.
present case is the first proved This case shows that patients
case of viral hepatitis B associated with with viral hepatitis can develop aplastic
and that the disease of at least some patients belongs to viral hepatitis HBS-antigenemia in hepatitis associated with aplastic anemia remains because of a small number of cases examined. Recently associations B with aplastic
glomerulonephritis and periarteritis nodosa are pointed out. anemia is also occasionally associated with viral hepatitis B.
aplastic anemia,
B. Incidence of to be determined of viral hepatitis
Now
it is clear
that
References
1)
Ajlouni, K. & Doeblin, T.D. (1974) The syndrome of hepatitis and aplastic anemia. Brit. J. Haematol., 27, 345-355. 2) Camitta, B.M., Nathan, D.G., Forman, E.N., Parkman, R., Rappeport, J.M. & Orellana, T.D. (1974) Posthepatitic severe aplastic anemia; An indication for early bone marrow transplantation. Blood, 43, 473-483. 3) Hodgkinson, R. (1973) The chloramphenicol-hepatitis-aplastic anaemia syndrome. Med. J. Austral., 1, 939-940. 4) Lorenz, E. & Quaiser, K. (1955) Panmyelopathie nach Hepatitis epidemica. Wien. med. Wochensch., 105, 19-22. 5) Toda, K. (1973) A case of aplastic anemia following infectious hepatitis . Nihon Shonika Gakkai Zasshi (Jap.), 77, 220.
J. exp.
Med.,
1975,
116, 101-102
Short
Viral
Hepatitis
B and
Aplastic
Snozo NAKAMURA, TAKASHI and YASUSHI SATO*
Report
Anemia
SATO,
TOSHIYUKI
MAEDA*
The First Departmentof Internal Medicine, Tohoku University Schoolof Medicine,Sendai, and HikarigaokaSpellmanHospital,* Sendai
NAKAMURA, and
T.,
Aplastic
SATO,
Anemia.
many
cases
nature
of
of
T.,
Tohoku
hepatitis is
not
anemia aplastic
T.
and
Med.,
with
fully
hepatitis-B-antigen-positive
antigen;
exp.
associated
hepatitis
aplastic
MAEDA,
J.
aplastic
A
case
is presented.?
has
acute
viral
hepatitis
Y.
Viral
(1),
There of
viral
116 anemia
understood.
case.
SATO,
1975,
Hepatitis
101-102 •\
have
been
been
so
described, far
no
hepatitis
B;
B
Although
B
hepatitis
the
report
of
developing
B;
hepatitis
B
anemia
Since the association of hepatitis and aplastic anemia was first described by Lorenz and Quaiser (1955), approximately 100 cases of this association have been reported (Camitta et al. 1974). Although some of them belong to the chloramphenicol-hepatitis-aplastic anemia syndrome (Hodgkinson 1973), most of them are believed to have had acute viral hepatitis (Ajlouni and Doeblin 1974; Camitta et al. 1974). In spite of recent advances in detecting hepatitis B surface antigen (HBSAg), however, no HBS-Ag-positive case has been reported. In this paper a case of acute viral hepatitis B developing aplastic anemia is Dresented. A
71-year-old
1974.
One
May
17.
history
He of
physical
was
serum
zinc
phils
65%,
Bone
marrow
anabolic and
consistent
aplastic
lymphocytes
29%,
with
S.G.O.T.
and
weeks
S.G.P.T.
almost
after
to rose
the
for publication,
more
rest,
returned
increased
Hemoglobin
Received
with
Three
albumin
remained
controls,
treated
and
to same.
March
was
jaundice
to
2
normal
g/100ml
Thrombocytes
24, 1975. 101
7.0%, ƒÀ-
7.9
g/100ml,
thrombocytes
very
low
given
blood
red
2,22O/ƒÊ1
and
rate
(neutro 102,000/ƒÊ1.
myeloid
and
months
and ƒÁ-globulin
12.4
Total
of
erythroid
incorporation
236•~103dpm).
subsequently
admission
60.3%
2%),
had
than
test
units.
immunodiffusion.
count
megakaryocytes,
lymphocytes
(5•~103dpm; was
monocytes
sub
alkaline
turbidity
radial
cell
no
and
units,
515
hemoglobin blood
on
admission,
gingiva, 449
thymol
by
April,
was
2.3%, ƒ¿2-globulin
white
decreased
nose,
72,
positive
anemia;
0.5%,
Phytohemagglutinin-stimulated
patient
was
On
dehydrogenase
38.3%, ƒ¿l-globulin
with
hypocellular,
lactic
of admitted
There
S.G.P.T.
index
and
HBSAg
reticulocytes
4%,
was
admission. count
was
eosinophils
steroid.
gradually;
albumin 46.0%.
2,29O,000/ƒÊ1,
3H-thymidine The
g/100ml,
and ƒÁ-globulin
count
elements. of
8.8
units,
the
units,
prothrombin
48
middle was
admission.
from 840
the he
transfusion.
the
bleeding
in and
blood before
S.G.O.T.
units, test
fatigue
appeared,
drugs and
50,
noticed
received
other
was
he
bleeding not
jaundice
turbidity
were
picture
cell
had or
index
until
nasal
and
King-Armstrong
6.4%, blood
health and
revealed
sulphate
proteins
blood
good
abstainer,
Icterus
13.4
globulin
in
jaundice
chloramphenicol
tissue.
units,
The
an
taking
phosphatase
was
later
examination
cutaneous
11.7
male
month
later.
Serum
decreased after
transfusion
HBS-antigenemia
to
6
months,
increased
to
22.0% but
124,000/ƒÊl,
and
an
disappeared, globulin 6
improved months
white
after
blood and
bleeding
cell
102 stopped. slightly
The sternal hvpocellular.
marrow
showed
S. Nakamura
et al.
increases
in erythroid
and myeloid
cells, but remained
Although many cases of hepatitis developing aplastic anemia have been so far reported, the nature of hepatitis is not fully understood. The chloramphenicol-hepatitisaplastic anemia syndrome was proposed rather than viral hepatitis (Hodgkinson 1973). When viral hepatitis was considered, acute viral hepatitis A was suggested since HBSAg was negative in the patients tested (Ajlouni and Doeblin 1974). However, HBSAg was so far examined in only a small number of reported cases (Toda 1973; Ajlouni and Doeblin 1974; Camitta et al. 1974). The anemia.
present case is the first proved This case shows that patients
case of viral hepatitis B associated with with viral hepatitis can develop aplastic
and that the disease of at least some patients belongs to viral hepatitis HBS-antigenemia in hepatitis associated with aplastic anemia remains because of a small number of cases examined. Recently associations B with aplastic
glomerulonephritis and periarteritis nodosa are pointed out. anemia is also occasionally associated with viral hepatitis B.
aplastic anemia,
B. Incidence of to be determined of viral hepatitis
Now
it is clear
that
References
1)
Ajlouni, K. & Doeblin, T.D. (1974) The syndrome of hepatitis and aplastic anemia. Brit. J. Haematol., 27, 345-355. 2) Camitta, B.M., Nathan, D.G., Forman, E.N., Parkman, R., Rappeport, J.M. & Orellana, T.D. (1974) Posthepatitic severe aplastic anemia; An indication for early bone marrow transplantation. Blood, 43, 473-483. 3) Hodgkinson, R. (1973) The chloramphenicol-hepatitis-aplastic anaemia syndrome. Med. J. Austral., 1, 939-940. 4) Lorenz, E. & Quaiser, K. (1955) Panmyelopathie nach Hepatitis epidemica. Wien. med. Wochensch., 105, 19-22. 5) Toda, K. (1973) A case of aplastic anemia following infectious hepatitis . Nihon Shonika Gakkai Zasshi (Jap.), 77, 220.
