Abstract

Megha K. Mukundan, Sukdev Manna, Minakshi Dhar* and Rohit Gupta

ABSTRACT

Hepatitis B infection is quite common infection in this part of North India. The clinical presentation and complications of acute hepatitis B are related to onset and extent of liver failure. Here we report a very rare complication of acute hepatitis B in 61-year-old male patient. He was admitted with features of acute hepatic failure with grade 1 encephalopathy and coagulopathy. Patient was started on Tab Tenofovir 300 mg/day along with supportive and symptomatic treatment. Patient was improving clinically and laboratory parameters also showed improving trend. On day 8 of admission patient had a syncopal attack. Investigations revealed significant drop in haemoglobin level from 15.8 gm/dl to 5.8 gm/dl. Liver function showed improvement except increase in serum bilirubin. Other investigations revealed high LDH, haemoglobinuria, low haptoglobin with peripheral blood smear suggestive of acute haemolysis. Direct Coomb’s test was negative. G6PD values were normal limits. Diagnosis of non-haemolytic anaemia secondary to acute hepatitis B infection was made. Patient was transfused 8 units of packed red blood cells in between in view of low haemoglobin. He was started on oral steroids in view of rapid fall in haemoglobin level despite blood transfusion. Haemoglobin improved over two weeks to 10.7 mg/dl. He is doing well with steady rise in haemoglobin level even after stopping of steroid after gradual tapering over a period of 1 month. According to previously published data acute viral hepatitis especially A, B, E mono or co-infection decreases lifespan of RBCs, but rarely results in severe life threatening haemolytic anaemia and that too in absence of pre-existing blood cell and liver pathology.