Aplastic anemia following viral hepatitis: report of two fatal cases and literature review

Abstract

Within recent years the combination of aplastic anemia following viral hepatitis has been reported with increasing frequency suggesting the existence of a causal relationship between the two conditions. Two case histories of aplastic anemia following hepatitis are presented in detail, and the information on 193 such patients reported in the literature through 1972 is summarized. A number of parameters were evaluated and extensive cross correlation carried out in order to define criteria which might have diagnostic, prognostic or therapeutic value. Males were more likely to develop bone marrow failure following hepatitis (p congruent to 0.05), but females were less likely to survive the marrow depression (p smaller than 0.025). No other statistically identifiable criteria were detected. The hematologic changes commonly encountered in hepatitis are reviewed. These and other observations support the concept that subclinical hepatitis may be responsible for a significant percentage of so-called idiopathic aplastic anemia, for which, at present, no etiology can be determined in nearly half the cases. Possible pathogenetic mechanisms are discussed as they might relate to chromosomal abnormalities which were found in one of our patients. It is suggested that occasional fortuitious human infection with animal viruses known to be both hepato- and myelotoxic could relate the hepatitis and aplasia.