The clinical and immune characteristics of patients with hepatitis-associated aplastic anemia in China

PLoS One. 2014 May 20;9(5):e98142. doi: 10.1371/journal.pone.0098142. eCollection 2014.

Abstract

Hepatitis-associated aplastic anemia (HAAA) is a variant of severe aplastic anemia (SAA) in which bone marrow failure follows an acute attack of hepatitis. Its pathogenesis is poorly understood. We investigated the prevalence of HAAA among cases of newly diagnosed SAA presenting to our hospital between January 1998 and February 2013, and analyzed the clinical and immune characteristics of HAAA and non-hepatitis-associated SAA (non-HASAA) patients. The prevalence of HAAA among cases of SAA was 3.8% (36/949), and the majority of patients (33/36) were seronegative for a known hepatitis virus. Compared with non-HASAA patients, HAAA patients had a larger proportion of CD8+ T cells, a lower ratio of CD4+/CD8+ T cells, and a smaller proportion of CD4+CD25+ regulatory T cells. There was no significant difference in peripheral blood count, bone marrow cellularity, or the number of blood transfusions received between HAAA and non-HASAA patients. HAAA patients had a higher early infection rate and more infection-related mortality in the first 2 years after diagnosis than non-HASAA patients, and their 2-year survival rate was lower. The results demonstrate that HAAA patients have a more severe T cell imbalance and a poorer prognosis than non-HASAA patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia, Aplastic / immunology
  • Anemia, Aplastic / mortality
  • Anemia, Aplastic / pathology*
  • Anemia, Aplastic / virology
  • Child
  • Child, Preschool
  • China / epidemiology
  • Female
  • Hepatitis, Viral, Human / immunology
  • Hepatitis, Viral, Human / mortality
  • Hepatitis, Viral, Human / pathology*
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • T-Lymphocytes / immunology*
  • Young Adult

Grants and funding

This project is partly supported by Natural Science Foundation of China (No. 30971286, 30971285, 81170472, 81370607). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study.