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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.