Nadeem Ikram, Khalid Hassan, Samina Tufail.
Hepatitis associated autoimmune hemolytic anemia.
Int J Pathol Jan ;2(1):44-6.

A seven years old male child presented with complaints of nausea, vomiting, dark coloured urine, yellowish discoluration of sclera. On examination he was having jaundice alongwith pallor and mild hepatosplenomegaly. On laboratory investigations he was found anaemic with a haemoglobin level of 5.1g/dl. Red Blood cells morphology was microcytic hypochromic, with spherocytosis and a reticulocyte count of 5.0%. His liver function tests showed a bilirubin level of 5.0 mg/dl with a predominant conjugated component, ALT of 2500 U/l, Alkaline Phosphatase level of 295U/l and Albumin level of 4.5 g/dl. A blood transfusion was suggested. In blood bank the patient`s blood failed to show compatibility with blood group compatible donors. His Coombs` test (Direct and Indirect) was performed and that was found to be positive. Serum LDH showed raised levels (1200 IU/l). Hepatitis Viral studies showed negative results for Antibodies to Hepatitis C Virus and Hepatitis B Surface Antigen, but Anti Hepatitis A virus IgM was positive. Subsequently the patient was put on steroids and he showed response to treatment with an improvement in Haemoglobin level (10.0 g/dl). At present his liver function tests are within normal limits, but Coombs` test is positive.

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