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Clinical characteristics of hepatitis-associated aplastic anemia in children

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Abstract

To understand the current situation of hepatitis-related aplastic anemia (HAAA) in children, we analyzed the patients with HAAA admitted to our hospital in the past 5 years to understand the disease characteristics and prognosis. The clinical data of patients with HAAA admitted to our hospital from February 2017 to May 2022 were retrospectively analyzed. A total of 81 patients with HAAA, 56 males and 25 females. The median onset age was 5.9 years. The median time from hepatitis to occurrence of hemocytopenia was 30 days, and the median follow-up time was 2.77 years. There were 23 cases (28.5%) of severe aplastic anemia (SAA), 50 cases of very severe aplastic anemia (VSAA), and 8 cases of non-severe aplastic anemia (NSAA). At the beginning of the disease, cytotoxic T lymphocyte (CTL) was higher than normal in 60% of patients, and the median CD4/CD8 ratio was 0.2. As of follow-up, 72 children survived, 4 were lost, and 5 died. Thirty-four cases were treated with immunosuppressive therapy (IST), with a median follow-up time of 0.97 years. The total reaction rate was 73.5% (25/34), the complete reaction rate was 67.6% (23/34), and the nonreaction rate was 26.5% (9/34). Multivariate analysis suggested that co-infection was an independent risk factor affecting the efficacy of IST at 6 months, with an OR value of 16.76, 95% CI (1.23, 227.95), P=0.034. No independent influencing factors were found at the end of follow-up. The proportion of CTL cells in peripheral blood of children with HAAA is relatively increased, and IST is effective in 73.5% of children. Co-infection may prolongs the time to response to IST.

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The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

We thank all the patients and their families for their kind cooperation. We thank all the clinical team members who provided care for patients.

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Author notes

  1. Lingling Fu and Jialu Zhang have contributed equally to this work.

Authors and Affiliations

  1. Hematology Center, Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China

    Lingling Fu, Jialu Zhang, Ruixin Wang, Bixi Yang, Hongmin Li & Jie Ma

  2. Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045, China

    Hui Chen

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  1. Lingling Fu
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Contributions

L.F., J.Z. Writing - original draft; R.W., B.Y. Writing - review & editing; H.L., H.C., Data curation; L.F., J. M. Formal analysis; J. M. Project administration.

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Correspondence to Jie Ma.

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This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (IRB) of Beijing Children’s Hospital, Capital Medical University.

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All parents signed informed consent forms and approved the final manuscript.

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Fu, L., Zhang, J., Wang, R. et al. Clinical characteristics of hepatitis-associated aplastic anemia in children. Ann Hematol 103, 397–404 (2024). https://doi.org/10.1007/s00277-023-05566-y

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