- 期刊
Autoimmune Hemolytic Anemia in a Patient with Combination Therapy for Hepatitis C: Report of a Case
C型肝炎接受合併療法併發自體免疫溶血性貧血：一病例報告
摘要
自體免疫溶血性貧血是C型肝炎治療過程中少見的併發症，我們報導的這個病例是一個49歲的男性病人，於5年前曾因C型肝炎而接受干擾素的治療但不久復發，他於2000年10月於本院再次接受干擾素合併ribavirin治療並於24週後因病情穩定而停藥，不幸C型肝炎於停藥2週後復發而病人再次接受合併療法，貧血(Hb7.6)出現在第二次開始治療12週後，因為輸血治療效果不好，因此病入入院檢查而被診斷出自體免疫溶血性貧血，病人的貧血在免疫抑制治療之後獲得改善，所以我們假設慢性C型肝炎造成病人免疫的異常，而干擾素的治療則刺激自體抗體的產生，進而引發自體免疫溶血性貧血。
並列摘要
Autoimmune hemolytic anemia (AIHA) is a rare complication during combination therapy with interferon and ribavirin for hepaitis C infection. We report such a case. A 49y/o male patient, who used to be a victim of hepatitis C, and he had received therapy with interferon for C hepatitis 5years ago, but biochemical and virological relapse happened. Subsequently he received combination therapy with interferon a-2b 5MU three time per week and ribavirin 1200mg/day for 6 months since 2000 October. But biological relapse occurred after the medication were discontinued for 2 months. Retreatment was tried. Unfortunately, refractory anemia occurred after 12 weeks of therapy. His lab data was hemoglobin: 7.6 g/dL, hematocrit: 22.6%, total bilirubin 3.6 mg/dL, GOT 148 U/L, GFT 114U/L, LDH 2545 U/L direct and indirect Coomb's test: positive, reticulocyte: 9.8%, hepatoglobin＜5.83mg/dL. The hemoglobin level did not elevate after washed FRBC transfusion. Autoimmune hemolytic anemia was diagnosed. His anemia improved after prednisolone and azathioprine therapy. We postulate the patient had some immunologic abnormalities due to chronic hepatitis C infection, and additional interferon therapy may have stimulated the production of autoantibodies to red blood cells leading to the development of AIHA.
延伸閱讀
- Chen, S. H., Peng, C. Y., Lai, H. C., Lin, C. H., Kao, J. T., Chuang, P. H., Su, W. P., Lin, C. M., & Chen, C. H. (2013). 感染第二型病毒基因型之C型肝炎病患接受長效型干擾素合併Ribavirin治療時，肌苷三磷酸焦磷酸酶（ITPA）基因之單一核苷酸多型性與溶血性貧血之相關性. 臺灣消化醫學雜誌, 30(3), 256-266. https://doi.org/10.6557/GJT.201309_30(3).0002
- Liu, C. H. (2015). 慢性C型肝炎病毒基因型第一型病患之優化治療 [doctoral dissertation, National Taiwan University]. Airiti Library. https://doi.org/10.6342/NTU.2015.00064
- Cheng, C. L., Lin, D. Y., Huang, S. F., Hung, C. F., & Leu, H. S. (2000). 失償性肝硬化及肝細胞癌病人合併後天免疫不全症候群及巨細胞病毒性胃炎：一病例報告. 中華民國消化系醫學雜誌, 17(2), 154-161. https://doi.org/10.6557/GJTb.200006_17(2).0006
- Chen, J. S., Young, T. H., Chao, Y. C., Tang, H. S., Yan, J. C., Chen, Y. C., & Lee, H. S. (1998). 反應性血球吞噬症候群在急性B型肝炎之病患－病例報告. 中華民國消化系醫學雜誌, 15(1), 8-13. https://doi.org/10.6557/GJTb.199803_15(1).0002
- Wu, J. M., Huang, Y. H., Yang, C. F., Lee, P. C., Chan, C. C., & Lin, H. C. (2009). 慢性B型肝炎急性發作併發純粹紅血球發育不全. 臺灣消化醫學雜誌, 26(2), 195-201. https://doi.org/10.6557/GJT.200906_26(2).0008