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Grand Rounds
July 21, 1999

Acquired Aplastic Anemia

Author Affiliations

Author Affiliation: Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.


Grand Rounds at the Clinical Center of the National Institutes of Health Section Editors: John I. Gallin, MD, the Clinical Center of the National Institutes of Health, Bethesda, Md; David S. Cooper, MD, Contributing Editor, JAMA.

JAMA. 1999;282(3):271-278. doi:10.1001/jama.282.3.271

A 27-year-old man noted that his eyes were yellow. Questioning elicited a recent history of darkened urine, light-colored stools, and fatigue. His physician palpated a tender enlarged liver; hepatic function test results were abnormal, with levels of total bilirubin at 75 µmol/L (4.4 mg/dL), alanine aminotransferase at 2587 U/L, and aspartate aminotransferase at 856 U/L. Within 2 weeks, the levels of total bilirubin had risen to 616 µmol/L (36 mg/dL), the alanine aminotransferase to 2209 U/L, and the aspartate aminotransferase to 1190 U/L. The patient had a history of possible hepatitis virus exposure in his employment as a police officer, but serologic testing results, including polymerase chain reaction amplification, were negative for infection with hepatitis A, B, and C viruses. A liver biopsy specimen showed severe panlobular hepatitis with extensive intralobular cholestasis. Kupffer cells were prominently enlarged, and there was a sinusoidal infiltrate consisting mainly of T cells.