Hepatitis A Infection Presented with Pancytopenia, a Case Series in Children

Extrahepatic presentation in hepatitis is a relatively uncommon clinical condition. In particular, pancytopenia related to hepatitis is a rare phenomenon encountered in these patients. Pancytopenia can be associated with a variety of hepatitis viruses; however, its association with hepatitis A virus (HAV) is unusual. In current case series, we reported 11 children who presented with three suppressed blood lineages, including white blood cells, platelets, reticulocytes, and hemoglobin with mean values of 2.4 × 103/µL, 54.5 × 103/µL, 1%, and 9.4 g/dL. Of these 11 children, 5 were boys. The mean age was 6.5 years old. The patients presented with abdominal pain, hepatitis, and pallor. Biochemical analysis showed liver function enzymes were increased in all patients. Serologic studies for antibodies against viral components, including hepatitis B (HBV), hepatitis C (HCV), and HAV, as well as cytomegalovirus (CMV) showed positive results for anti-HAV IgM. Coombs tests were negative in all the patients. Clinicians should consider extrahepatic presentations of hepatitis infections, especially HAV infection that may present with non-specific clinical features. This can help health care providers to timely and correct diagnosis and treatment of this infection.