Overview.
Post-hepatitis aplastic anemia, referred to as post-hepatitis remittent syndrome, is a disease that occurs in the late stages of acute or chronic hepatitis, with peripheral whole blood cytopenia and decreased proliferation of bone marrow trilineage cells, and is clinically characterized by anemia, hemorrhage, and infection. The disease is prevalent in young people, which is related to the high incidence of hepatitis, and is more common in males.
Etiology
Related to viral infection, literature reports that all types of viral hepatitis can occur, Beijing Ditan Hospital has summarized 25 cases of post-hepatitis recrudescence between 2004 and 2009, of which 12 cases were chronic hepatitis B, 4 cases were chronic hepatitis C, 1 case was acute hepatitis E, 1 case was hepatitis megaloblastic, and 7 cases were unfractionated hepatitis.
Symptoms
The clinical manifestations of posthepatitis reentry are that liver function has been restored and the liver is not large in size within a few months after acute or chronic hepatitis. Patients gradually develop mental depression, poor appetite, fatigue, pallor and other manifestations, which rapidly worsen. Severe patients show symptoms of fever, infection and bleeding from the skin and mucous membranes, gastrointestinal bleeding.
Examination
1. Laboratory examination
(1) Blood picture The counts of white blood cells, red blood cells and platelets in peripheral blood are significantly reduced, or one of the blood cells can be selectively suppressed.
(2) Bone marrow image The bone marrow is hypoproliferative in all lineages, or hypoproliferative in a single lineage.
(3) Virological examination Hepatitis B, C, E and other virological or serological markers are positive.
2. Other auxiliary examinations
Chest X-ray, ultrasound, CT, etc. are selected according to clinical needs.
Diagnosis
The patient has a history of acute or chronic hepatitis activity, with obvious symptoms of anemia, infection and bleeding during hepatitis recovery. Diagnosis can be made when routine blood tests show a decrease in whole blood cells and bone marrow pathology shows a decrease in the proliferation of the three lineages.
Differential diagnosis
It is easy to differentiate from other causes of recrudescence with a history of hepatitis and laboratory tests.
Complications
Severe disease and rapid progression of the disease often complicate ischemia and hypoxia and cardiac insufficiency; severe infection and internal bleeding, especially intracranial hemorrhage often endanger the patient’s life; cardiac insufficiency, jaundice, hepatosplenomegaly; severe infection and massive bleeding are fatal complications.
Treatment
1. Allogeneic hematopoietic stem cell transplantation
Allogeneic hematopoietic stem cell transplantation is a therapeutic means of treating remyelination, and it can be a preferred method for hematopoietic stem cell injury type remyelination. The success rate of transplantation is higher when siblings with compatible human leukocyte antigen (HLA) tissue matches are used.
2. Immunosuppressive therapy
Compared with other immunosuppressive agents, cyclosporine A has selective inhibitory effect on T cells and less toxicity to bone marrow hematopoietic stem cells, and has the function of regulating T cell subsets.
3. Plasma exchange therapy
For patients with significant increase in serum immune complexes or immunoglobulins, plasma exchange can be used to reduce the concentration of serum antibodies or bone marrow regeneration inhibitors.
4. Traditional Chinese Medicine (TCM)
The selection of Da Tonic Yuan Decoction, which benefits qi and nourishes yin, such as Codonopsis pilosulae, Astragalus membranaceus, and Radix Rehmanniae, is conducive to alleviating the patient’s symptoms of blood loss due to deficiency and labor, blood deficiency due to internal injuries, and deficiencies in the organs and essence.
5. Other symptomatic treatment measures
Anti-infection treatment for complication of infection, hemostasis treatment for bleeding.
Prognosis
The prognosis of the disease is poor, the main causes of death are infection and bleeding, and some patients die of liver failure.
Prevention
1. Strengthen health care during pregnancy to prevent various infectious diseases during pregnancy, especially hepatitis B virus, cytomegalovirus, rubella virus, herpes simplex virus, congenital syphilis, etc., so as not to cause liver damage to the affected children and the occurrence of this disease.
2. Timely immunization in accordance with the national immunization plan to reduce the risk of hepatitis B virus and other viral infections.
3. In view of the characteristics of this disease, especially young adults under 20 years old who have leukopenia and thrombocytopenia at the early stage of hepatitis, close observation should be made, especially within 20 weeks after the onset of hepatitis, regular observation of blood changes should be made for early detection of this disease and effective measures should be taken in time.