Clinical Analysis Of 68 Cases Of Pancytopenia With HBsAg

Decreased blood cell disease such as ITP, MDS, AA, AIHA, pancytopenia syndrome are clinical common diseases. The relationship between AA and hepatitis have been clearly defined, while ITP, MDS, AA, AIHA,pancytopenia syndrome may also caused by hepatitis virus infection. Think about the fact that the rate of HBV infection was high in China, to explore the relationship of hepatitis virus infection and abnormal blood cells-reduction owned important clinical significance.Objective: To analysis with HBV infection in blood cells decreased disorders, including ITP, MDS, AA, AIHA, pancytopenia, including the clinical characteristics, laboratory abnormalities and the relationgship with HBV infection. Explored the possible mechanisms for pancytopenia correlated with HBV infection.Methods: Selected 68 patients who were diagnosed with ITP, MDS, AA, AIHA , pancytopenia syndrome for first time from the hematology and hepatology department, during January 1, 2005 to May 1, 2009 in out hospital, and they were accompanied by HBsAg positive at the same time. Then, inspected the cases'details concluding the incidence of the disease, clinical manifestations, laboratory features, and summarize the similarities and differences.Results:⑴. Among the 68 cases of blood cell abnormalities (ITP, MDS, AA, AIHA,pancytopenia syndrome) with HBsAg, ITP was the most and AIHA and pancytopenia syndrome were the least.⑵. Among 68 cases of pancytopenia syndrome patients with HBsAg positive:①mainly were the young people ( the average age was 37 ), male to female ratio was 1.27:1, the proportion of female among ITP and the proportion of male were significantly higher than others (P<0.05).②55.9% patients had no history of viral hepatitis, especially MDS.③the bone marrow morphology changes of MDS with HBsAg were mainly megaloblastic, and the changes of other diseases had no specific.⑶. Among all the 1414 cases of ITP, MDS, AA, AIHA,pancytopenia syndrome patients, HBV screen rate was 80.6% and 51% of those patient had abnormal results; the abnormal results in ITP, AA, AIHA,pancytopenia syndrome were mainly the serological markers including HBsAb, and this proportion was significantly higher than MDS (P<0.05).⑷. Classified 81 cases of MDS patients with HBV infection based on WHO standards, RCMD/RCMD-RS was 70% in the HBsAg positive group, and the proportion was significantly higher than the HBsAg negative group (P<0.05).Conclusion: 1. 68 cases with HBsAg blood cell reduction diseases, including ITP 27 (40%), MDS 20 (29%), AA 13 (19%), AIHA and pancytopenia syndrome all 8 cases(a total of 12%). 2. HBV infection may be related with the blood cells disorder disease---- ITP, MDS, AA, AIHA,pancytopenia syndrome. 3. The bone marrow of ITP, AA, AIHA with HBsAg-positive had no specific compared with ordinary ITP, AA, AIHA; MDS with HBsAg-positive had lower age, bone marrow dysplasia were mainly the megaloblastic, the chromosome were normal karyotype, and IPSS risk stratification were lighter. 4. ITP, AA, AIHA,pancytopenia syndrome , secondary MDS could happened in all the stages during the natural course of HBV infection, but ITP, AA, AIHA,pancytopenia syndrome occurred mainly in the recovery or chronic phase while secondary MDS mainly occured in the early stage of infection (acute and clearance phase). 5. Among the 1414 cases, 80.6% took the test for HBV, 51% had positive results, and the ratio of HBsAg was 5.97%. 6. The pathogenesis of blood cell reduction associated with HBsAg-positive may caused by immune abnormalities, suggesting that the treatment could include immune-therapy and monitoring T-cell subsets.