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Resolution of acute hepatitis B-associated aplastic anaemia with antiviral therapy
  1. Nicholas Hendren1,
  2. Joseph Moore1,
  3. Sandra Hofmann2,
  4. Siayareh Rambally2
  1. 1Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
  2. 2Division of Hematology and Oncology, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  1. Correspondence to Dr Nicholas Hendren, nicholas.hendren{at}


A previously healthy 44-year-old woman presented with 3 days of worsening petechial rash, epistaxis and fatigue. Admission labs revealed pancytopenia, low reticulocyte index and elevated liver enzymes. Bone marrow biopsy demonstrated a profoundly hypocellular bone marrow without dysplasia and additional testing demonstrated an acute hepatitis B infection. In the context of an acute hepatitis B infection, elevated liver enzymes and aplastic anaemia, our patient was diagnosed with severe hepatitis-associated aplastic anaemia due to an acute hepatitis B infection. She was initiated on antiviral therapy with tenofovir and briefly received immunosuppressive therapy with a robust sustained improvement in her blood counts. Acute hepatitis B-associated aplastic anaemia is an exceptionally rare presentation of aplastic anaemia. We present acute hepatitis B-associated aplastic anaemia that resolved with antiviral therapy, which to our knowledge is the second such case reported in the literature and the first using tenofovir.

  • hepatitis (sexual health)
  • malignant and benign haematology
  • hepatitis and other gi infections
  • hepatitis b
  • haematology (drugs and medicines)

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  • Handling editor Seema Biswas

  • Contributors NH authored several drafts of the clinical vignette and obtained patient consent. JM edited the drafts and provided feedback in addition to obtaining clinical images. SH edited the drafts and provided professional expertise, edits and recommendations. SR was the senior author who critically reviewed the drafts and verified our citations serving as the guarantor of content. All authors approve the current draft for submission and resume responsibility for the accuracy and integrity of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.