Clinical analysis of the characteristics of patients diagnosed with hemolytic anemia induced by hepatitis E viral infection

The extrahepatic manifestations of hepatitis E virus (HEV) infection include hemolytic anemia. However, the clinical characteristics of HEV-induced hemolytic anemia have been only sporadically reported in case reports, and there is a scarcity of relevant systematic reviews. The aim of the current study was to analyze and summarize the clinical characteristics of patients diagnosed with HEV-induced hemolytic anemia. This study included 1 patient diagnosed with HEV-induced hemolytic anemia who was admitted to our hospital and 19 additional patients identified through the available literature. Of the 20 patients included in this study, the majorities were from China and India (12 and 6 cases, respectively); furthermore, 13 of them were men and 7 were women, with an average age of 35 (16–56) years. The highest total bilirubin level was 646 (452–913) μmol/L, highest alanine aminotransferase level was 1335 (708–2798) IU/L, and lowest hemoglobin level was 6.0 ± 2.0 g/dL. Additionally, 10 patients (50.0%, 10/20) underwent the glucose-6-phosphate dehydrogenase (G6PD) activity test, and all of them were diagnosed with G6PD deficiency (100.0%, 10/10). Finally, 18 patients (90.0%) recovered and 2 died (10.0%) after treatment. Most of the patients with HEV-induced hemolytic anemia recovered with treatment. Acute HEV infection that causes hemolytic anemia is strongly associated with the G6PD status of the patients.