Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1985 Nov;61(721):971–975. doi: 10.1136/pgmj.61.721.971

Acute viral hepatitis, intravascular haemolysis, severe hyperbilirubinaemia and renal failure in glucose-6-phosphate dehydrogenase deficient patients.

R K Agarwal, A Moudgil, K Kishore, R N Srivastava, R K Tandon
PMCID: PMC2418469  PMID: 4070114

Abstract

Five patients with acute viral hepatitis developed severe intrasvascular haemolysis and unusually high levels of serum bilirubin (427 to 1368 mumol/l). All 5 had high fever, marked anaemia, reticulocytosis and neutrophilic leucocytosis. Three of them developed acute renal failure, which was of non-oliguric type in 2. The clinical course was protracted, but complete recovery occurred in 4 patients between 4 to 10 weeks. One patient with hepatic coma and oliguric renal failure died. Deficiency of the enzyme G-6-PD was confirmed in 4 cases. Massive haemolysis in the patients was probably induced by the administration of chloroquine and other drugs. Intravascular haemolysis should be suspected in patients with acute viral hepatitis, if they show unexplained anaemia and very high serum bilirubin levels, and measures to prevent renal failure should be instituted in such cases.

Full text

PDF
971

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BREWER G. J., TARLOV A. R., ALVING A. S. The methemoglobin reduction test for primaquine-type sensitivity of erythrocytes. A simplified procedure for detecting a specific hypersusceptibility to drug hemolysis. JAMA. 1962 May 5;180:386–388. doi: 10.1001/jama.1962.03050180032008. [DOI] [PubMed] [Google Scholar]
  2. Chan T. K., Todd D. Haemolysis complicating viral hepatitis in patients with glucose-6-phosphate dehydrogenase deficiency. Br Med J. 1975 Jan 18;1(5950):131–133. doi: 10.1136/bmj.1.5950.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Choudhry V. P., Madan N., Sood S. K. Intravascular haemolysis and renal insufficiency in children with glucose-6-phosphate dehydrogenase deficiency, following antimalarial therapy. Indian J Med Res. 1980 Apr;71:561–566. [PubMed] [Google Scholar]
  4. Green J., Beyar R., Bomzon L., Finberg J. P., Better O. S. Jaundice, the circulation and the kidney. Nephron. 1984;37(3):145–152. doi: 10.1159/000183235. [DOI] [PubMed] [Google Scholar]
  5. Hamlyn A. N., Gollan J. L., Douglas A. P., Sherlock S. Fulminant Wilson's disease with haemolysis and renal failure: copper studies and assessment of dialysis regimens. Br Med J. 1977 Sep 10;2(6088):660–663. doi: 10.1136/bmj.2.6088.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Jolly J. G., Sarup B. M., Bhatnagar D. P., Maini S. C. Glucose-6-phosphate dehydrogenase deficiency in India. J Indian Med Assoc. 1972 Mar 16;58(6):196–200. [PubMed] [Google Scholar]
  7. Kattamis C. A., Tjortjatou F. The hemolytic process of viral hepatitis in children with normal or deficient glucose-6-phosphate dehydrogenase activity. J Pediatr. 1970 Sep;77(3):422–430. doi: 10.1016/s0022-3476(70)80010-5. [DOI] [PubMed] [Google Scholar]
  8. Morrow R. H., Jr, Smetana H. F., Sai F. T., Edgcomb J. H. Unusual features of viral hepatitis in Accra, Ghana. Ann Intern Med. 1968 Jun;68(6):1250–1264. doi: 10.7326/0003-4819-68-6-1250. [DOI] [PubMed] [Google Scholar]
  9. PITCHER C. S., WILLIAMS R. Reduced red cell survival in jaundice and its relation to abnormal glutathione metabolism. Clin Sci. 1963 Apr;24:239–252. [PubMed] [Google Scholar]
  10. Roche-Sicot J., Benhamou J. P. Acute intravascular hemolysis and acute liver failure associated as a first manifestation of Wilson's disease. Ann Intern Med. 1977 Mar;86(3):301–303. doi: 10.7326/0003-4819-86-3-301. [DOI] [PubMed] [Google Scholar]
  11. SCHALM L., WEBER A. P. JAUNDICE WITH CONJUGATED BILIRUBIN IN HYPERHAEMOLYSIS. Acta Med Scand. 1964 Nov;176:549–553. doi: 10.1111/j.0954-6820.1964.tb00657.x. [DOI] [PubMed] [Google Scholar]
  12. Salen G., Goldstein F., Haurani F., Wirts C. W. Acute hemolytic anemia complicating viral hepatitis in patients with glucose-6-phosphate dehydrogenase deficiency. Ann Intern Med. 1966 Dec;65(6):1210–1220. doi: 10.7326/0003-4819-65-6-1210. [DOI] [PubMed] [Google Scholar]
  13. Tandon B. N., Gandhi B. M., Joshi Y. K. Etiological spectrum of viral hepatitis and prevalence of markers of hepatitis A and B virus infection in north India. Bull World Health Organ. 1984;62(1):67–73. [PMC free article] [PubMed] [Google Scholar]
  14. Wilkinson S. P., Davies M. H., Portmann B., Williams R. Renal failure in otherwise uncomplicated acute viral hepatitis. Br Med J. 1978 Jul 29;2(6133):338–341. doi: 10.1136/bmj.2.6133.338. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES