Hepatitis A virus infection is complicated by both pancytopenia and autoimmune hemolytic anemia (AIHA)

Introduction: Hepatitis A infection affects liver tissue primarily and might have some extrahepatic manifestations. Hematologically, the extrahepatic manifestations include aplastic anemia, red cell aplasia, and thrombocytopenia. There were reports about pancytopenia among patients with Hepatitis A infections, however, its association with autoimmune hemolytic anemia is rare as in our case.

Case presentation: A 30-year-old male visited the emergency room with tiredness, unmeasured fever, and jaundice. He also mentioned that recently he had anorexia and weight loss without night sweating. Initial laboratory findings showed pancytopenia and marked elevation of AST and ALT. Direct Coombs and IgM anti-Hepatitis A virus were positive. Consequently, he was diagnosed with HAV complicated by both pancytopenia and AIHA and treated with prednisone (1 mg/kg) leading to significant improvement in his anemia.

Discussion: This report describes a case of acute viral hepatitis A complicated with severe autoimmune hemolytic anemia and pancytopenia, which was successfully treated by high dose (1 mg/kg/day) prednisolone therapy.

Conclusion: This case represents a rare case in the literature review that can increase the awareness of the wide range of complications of HAV and its association with pancytopenia and AIHA.