Annals of Hematology

, Volume 97, Issue 9, pp 1741–1742 | Cite as

Massive hemolysis complicating acute granulomatous hepatitis

  • Adrià Carpio
  • Anna Merino
  • Sergio Rodríguez-Tajes
  • Enric ReverterEmail author
  • Miquel Bruguera
  • Xavier Forns
  • Javier Fernández
Letter to the Editor

Dear Editor,

A 51-year-old man was admitted to our hospital because of abdominal pain, fever, and jaundice. He reported a recent sexually risky contact. At admission, blood test revealed normal renal function and blood cell count and an acute hepatitis with AST/ALT 3560/4513 UI/L, total bilirubin 18 mg/dL, and INR 1.53. Liver ultrasound showed no alterations. The patient was hospitalized, received IV vitamin K, and underwent liver biopsy and a complete laboratory study. Within the next 48 h, his clinical condition markedly deteriorated with impairment of liver function (INR 1.83, total bilirubin 53.6 mg/dL—indirect 12.1 mg/dL), development of grade III acute kidney injury (creatinine 3.2 mg/dL), behavioral changes without flapping, and hemolytic anemia: hemoglobin decreased from 110 to 54 g/L, high reticulocyte count (19%) and low haptoglobin levels. Peripheral blood smear showed acute hemolysis with presence of “bite” cells and “blister cells,” as well as microspherocytes,...


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Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Liver and Digestive ICU, Liver Unit, Hospital ClínicBarcelonaSpain
  2. 2.Cytology Unit, Center for Biomedical Diagnosis, Hospital ClínicBarcelonaSpain

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