1991 Volume 32 Issue 6 Pages 650-656
A 70-year-old male was admitted because of general fatigue, itching and jaundice on January 22, '89. Laboratory findings showed that total bilirubin was 21.3mg/dl, TTT was 26.9KU and GOT was 99KU. Serum IgM anti-HAV was positive with 7.8 cut off index. Definite diagnosis of acute hepatitis A was made. On 15th hospital day, hemoglobin decreased to 4.3g/dl with reticulocytes of 0.1%.Total bilirubin was elevated to 23.7mg/dl with 16.6mg/dl of direct bilirubin, and associated with elevation of LDH of 1822WU. Analysis of LDH isozyme showed that LDH1 was 35%. Marked decrease of serum haptoglobin was observed. The finding of bone marrow on 23th hospital day revealed that marked hypoplasia of erythroid series. These results were consistent with pure red cell aplasia (PRCA) accompanied by hemolysis. Three units of washed red blood cell was transfused daily for four days. Oral administration of prednisolone was initiated from 60mg per day. On 73th hospital day the hemoglobin was improved within normal range. The peritoneoscopic finding of the liver and the microscopic finding of the liver biopsy specimen showed intrahepatic cholestasis.
