Chronic Liver Disease Presenting as Immune Hemolytic Anemia: The Challenges of Diagnosis in the Critically Ill in a Resource-Limited Health Care Setting.

Curēus
Kavita GaurRajinder K Dhamija

Abstract

Immune hemolytic anemia is very rarely associated with chronic liver disease. Diagnosis is often complicated in critically ill patients, where an etiological diagnosis can be elusive, especially in routine health care settings. A 48-year-old man presented with jaundice for three months. Ultrasonography showed features of chronic liver disease. Fibroscan showed increased parenchymal stiffness suggesting cirrhosis. Investigations revealed immune hemolytic anemia and thrombocytopenia. A percutaneous liver biopsy was not performed due to worsening thrombocytopenia. Isolated protein C deficiency and portal vein thrombosis were noted in subsequent testing. The patient eventually succumbed to illness. Coagulopathy such as protein C and D-dimer elevation discovered in subsequent rounds of testing may be misleading in rapidly deteriorating patients, emphasizing the need for timely coagulation workup and imaging. Despite comprehensive testing, lack of liver biopsy, as seen herein, may hamper clinical management. Training residents in the skill of transjugular liver biopsy is necessary to manage critical patients at secondary health care facilities.

References

Feb 27, 2009·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Don C RockeyUNKNOWN American Association for the Study of Liver Diseases
Jun 8, 2011·Journal of Thrombosis and Haemostasis : JTH·M J KovacsA Lazo-Langner
Mar 21, 2012·American Journal of Clinical Pathology·Riley B BallardUNKNOWN Education Committee of the Academy of Clinical Laboratory Physicians and Scientists
May 18, 2016·Hepatic Medicine : Evidence and Research·Oscar MitchellSamuel H Sigal
Jan 27, 2017·Experimental and Therapeutic Medicine·Yun LiXiaozhong Guo

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