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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 Reverter
  • Miquel Bruguera
  • Xavier Forns
  • Javier Fernández
Letter to the Editor
  • 62 Downloads

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,...

Notes

Compliance with ethical standards

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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