背景:再生障碍性贫血(AA)的特征是在没有异常浸润或网织蛋白纤维化增加的情况下全血细胞减少和骨髓细胞减少。由于细胞数量减少以及与其他骨髓衰竭综合征的形态学特征重叠,AA的诊断有时具有挑战性。肝炎相关再生障碍性贫血(HAAA)是一种罕见的变种,患者通常在6个月内出现黄疸和肝炎,然后出现全血细胞减少症。肝炎后AA约占病例的1-5%,而且这种病例对已知的肝炎病毒也是阴性的。有有限的文献来了解AA与肝炎的相关性,在我们地区的国家一级没有报道。与西方世界相比,东南亚的AA相对更普遍,肝炎是我们人口中的一种流行疾病,本研究的主要目的是评估肝谱,并在诊断时确定AA肝炎的相关性.
方法:国家血液病和骨髓移植研究所进行了一项横断面研究,卡拉奇,在患者知情同意后,从2019年11月至2020年12月。该研究包括所有没有服用类固醇的既往史的获得性AA患者,免疫抑制治疗,或者放化疗.肝功能检查,全血细胞计数,凝血酶原时间(PT),和活化部分凝血活酶时间进行,以及病毒谱(HAV,HepB,丙肝,和艾滋病毒)。SPSS版本23(IBMCorp.,Armonk,NY)用于统计分析。计算定量变量的平均值和标准偏差,同时报告定性变量的百分比和频率。使用T检验观察组间的主要差异,并且P值<0.05被认为是显著的。
结果:在总共351名患者中,29例(8.2%)AA患者的病毒性肝炎检测呈阳性。甲型肝炎是最普遍的肝炎(4.0%),其次是丙型肝炎(3.7%)。据报道,有和没有肝炎的患者的血小板计数比较具有统计学意义(p值<0.05)。在有和无肝炎的AA患者中,血小板计数和PT存在显着统计学差异(p值<0.0001)。
结论:总体而言,这项研究表明,<10%的AA患者对甲型肝炎筛查呈阳性,B,C和低血小板计数,与有和无肝炎的患者相比,PT具有统计学意义。在我们这个地区流行的肝炎可能与AA有重要的因果关系。AA患者应在诊断时筛查肝功能和病毒性肝炎。除了甲型肝炎,B,C和HIV,其他肝炎病因也应进行筛查,如细小病毒B19,人疱疹病毒16和腺病毒,这些不包括在常规诊断病毒检测组中.
BACKGROUND: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular marrow in the absence of an abnormal infiltrate or increase in reticulin fibrosis. The diagnosis of AA is challenging at times due to decreased cellularity and overlapping morphological features with other bone marrow failure syndromes. Hepatitis-associated aplastic anemia (HAAA) is a rare variant in which patients typically present with jaundice and hepatitis followed by pancytopenia almost within 6 months. Post-hepatitis AA accounts for approximately 1-5% of cases, and invariably such cases are negative for the known hepatitis virus as well. There is limited literature available to understand the correlation of AA with hepatitis with none reported at the national level in our region. As AA is relatively more prevalent in Southeast Asia as compared to the western world and hepatitis is a prevalent disease in our population, the main purpose of this study was to assess the hepatic profile and determine the association of hepatitis in AA at the time of diagnosis.
METHODS: A cross-sectional study was carried out at the National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, from November 2019 to December 2020 after the informed consent from patients. The study included all treatment-naïve patients of acquired AA with no prior history of taking steroids, immunosuppressive treatment, or chemoradiation therapy. Liver function tests, complete blood count, prothrombin time (PT), and activated partial thromboplastin time were performed, along with viral profiles (HAV, Hep B, Hep C, and HIV). SPSS version 23 (IBM Corp., Armonk, NY) was used for statistical analysis. Mean and standard deviations were computed for quantitative variables while percentages and frequencies were reported for qualitative variables. T-test was used to observe the main difference between groups and a p-value <0.05 was considered to be significant.
RESULTS: Out of a total of 351 patients, 29 (8.2%) patients with AA tested positive for viral hepatitis. Hepatitis A was the most prevalent hepatitis (4.0%), followed by hepatitis C (3.7%). The comparison of platelet counts in patients with and without hepatitis was reported to be of statistical significance (p-value < 0.05). A significant statistical difference (p-value < 0.0001) was found in platelet count and PT in patients of AA with and without hepatitis.
CONCLUSIONS: Overall, this study revealed that <10% of patients of AA had a positive screening for hepatitis A, B, and C and low platelet count, and PT was statistically significant when compared between the patients with and without hepatitis. Hepatitis being prevalent in our part of the world might have an important causal association with AA. Patients with AA should be screened for liver functions and viral hepatitis at the time of diagnosis. In addition to hepatitis A, B, and C and HIV, other causes of hepatitis should also be screened such as parvovirus B19, human herpes virus 16, and adenovirus which are not included in routine diagnostic viral testing panel.