Pancytopenia and atrial fibrillation associated with chronichepatitis C infection and presumed hepatocellular carcinoma: a case report
A 66 year old woman presented to the emergency department with shortness of breath and palpitations. She was found to have pulmonary edema secondary to a newly diagnosed atrial fibrillation.
She was treated with rate control and anti-coagulation. She was found to have an anemia that was reported to be longstanding and that was apparently being investigated by a hematologist, although no diagnosis had yet been achieved.
Her blood work also revealed a mild leucopenia and pronounced thrombocytopenia. The patient was admitted to ensure appropriate rate control of her atrial fibrillation and for work-up of her pancytopenia.Review of the bone marrow biopsy performed by the hematologist revealed a normal marrow with no infiltrative process.
The results of the patients blood tests ruled out a hemolytic process. There was also no evidence of infection, toxin ingestion, or recent medication that could be associated with pancytopenia.
An abdominal ultrasound was ordered to rule out splenomegaly and a possible consumptive coagulopathy. The spleen was of normal size, but the liver was mildly cirrhotic and a small solitary liver lesion was seen.
An MRI liver of the liver confirmed a single solitary solid mass and the alpha-fetal protein level in the serum was elevated. The patients preliminary viral serologies were positive for Hepatitis C.
The patient was diagnosed with presumed hepatocellular carcinoma and referred to hepatic surgeon for evaluation of treatment options.Pancytopenia secondary to hepatitis viral infection is a rare but noted clinical entity. An acute aplastic crisis usually occurs shortly after viral infection, however viral serologies are usually negative and the pancytopenia is often fatal if left untreated.
Milder more chronic presentations, such as this case, likely result from increased portal pressure generated from the resulting cirrhosis, which leads to a relative hypersplenism.
Author: Christopher Labos and Kaberi Dasgupta
Credits/Source: Journal of Medical Case Reports 2008, 2:264
Published on: 2008-08-11
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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