Patient Wu, male, 51 years old, case number XXXX103, was admitted to the anorectal ward of our hospital on March 24, 2014 with the main reason of “prolapsed anal contents with blood in stool for 5 years, aggravated for 2 months”. The patient had heavy bleeding in the past 2 months, and was admitted with routine blood tests: total white blood cell count 7.25*10~9/L, neutrophil percentage 72.8%, total red blood cell count 3.39*10~12/L, hemoglobin concentration 57g/L, total platelet count 129*10~9/L. Liver function: glutamate transaminase 25.0U/L aspartate aminotransferase 22.0U/L. Admission He was successfully operated for mole, and was treated with blood transfusion after surgery due to severe anemia. At the time of the consultation, the patient’s symptoms were: weakness, poor appetite, acceptable bowel movements, and sleepy and dreamy. The patient had a recent history of massive blood loss, no previous history of chronic liver disease, and a mild yellow staining of the skin and mucous membranes on examination. Ancillary tests: liver function series: direct bilirubin 12.0umol/L total bilirubin 50.6umol/L glutamate transaminase 458.0U/L aspartate aminotransferase 286.0U/L glutamyl transpeptidase 15.0U/L alkaline phosphatase 50.0U/L total protein 63.9g/L albumin 31.3g/L. Hemocoagulation 1+2: prothrombin time 16.3s prothrombin activity 55.0% INR value 1.42R. Hepatitis B five surface antibody 31.60e antibody 12.50 core antibody 0.06 hepatitis C antibody (-) abdominal ultrasound: fatty liver. The patient was seen to have abnormal liver function on this admission, with a hemagglutinin activity of 55.0% and a tendency to loss of liver function, which was considered to be related to long-term loss of blood and oxygen to the liver and reperfusion injury after blood transfusion. The patient had not been vaccinated against hepatitis B. However, the five hepatitis B tests showed surface antibody (+) e antibody (+) core antibody (+), so infection with occult hepatitis B was not excluded. Combining the medical history, signs and laboratory findings, the current diagnosis: 1. Abnormal liver function Chronic viral hepatitis B? Ischemia-reperfusion liver injury? 2. Hemorrhagic anemia, 3. Mixed hemorrhoids. Suggestions: 1. improve HBV-DNA test, except for occult viral hepatitis B. 2. liver protection and enzyme lowering treatment, can give reduced glutathione 1.2g IV QD; ezetimibe 0.456g oral TID. 3. avoid the application of drugs that impair liver function. 4. strengthen nutritional support, can give multivitamin supplementation to promote liver function recovery. 5. regular review of relevant laboratory tests. On April 3, he was rechecked for routine blood tests: total white blood cell count 6.25*10~9/L, neutrophil percentage 52.9%, total red blood cell count 3.39*10~12/L, hemoglobin concentration 66g/L, total platelet count 122*10~9/L. Liver function series: direct bilirubin 13.6umol/L total bilirubin 30.1umol/L glutathione transaminase 237.1U/L aspartate aminotransferase 53.7U/L glutamyl transpeptidase 18.3U/L alkaline phosphatase 81.2U/L total protein 62.7g/L albumin 32.1g/L hemagglutination 1+2: prothrombin time 15.6s prothrombin activity 58.0% INR value 1.36R. The patient’s malaise and dyspepsia improved, and the second stool was possible. The liver function was significantly better than before and the hemagglutination was better, suggesting recovery of liver function and improvement of the condition.