Liang HY, Xie XD, Jing GX, Wang M, Yu Y, Cui JF. Posthepatectomy jaundice induced by paroxysmal nocturnal hemoglobinuria: A case report. World J Clin Cases 2021; 9(32): 10046-10051 [PMID: 34877349 DOI: 10.12998/wjcc.v9.i32.10046]
Corresponding Author of This Article
Jian-Feng Cui, MD, Professor, Department of General Surgery, General Hospital of Western Theater Command, No. 260 Rongdu Avenue, Jinniu District, Chengdu 410000, Sichuan Province, China. cjfabear@126.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 16, 2021; 9(32): 10046-10051 Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.10046
Posthepatectomy jaundice induced by paroxysmal nocturnal hemoglobinuria: A case report
Hong-Yin Liang, Xiao-Dong Xie, Guang-Xu Jing, Meng Wang, Yang Yu, Jian-Feng Cui
Hong-Yin Liang, Xiao-Dong Xie, Jian-Feng Cui, Department of General Surgery, General Hospital of Western Theater Command, Chengdu 410000, Sichuan Province, China
Guang-Xu Jing, The Southwest Medical University, Luzhou 410000, Sichuan Province, China
Meng Wang, Department of Traditional Chinese Medicine, General Hospital of Western Theater Command, Chengdu 410000, Sichuan Province, China
Yang Yu, Department of Medical Examination, General Hospital of Western Theater Command, Chengdu 410000, Sichuan Province, China
Author contributions: Liang HY wrote the manuscript; Xie XD, Wang M, and Yu Y collected the data and drew the diagram; Jiang GX contributed to citations and references; Cui JF contributed to the discussion and revision; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Feng Cui, MD, Professor, Department of General Surgery, General Hospital of Western Theater Command, No. 260 Rongdu Avenue, Jinniu District, Chengdu 410000, Sichuan Province, China. cjfabear@126.com
Received: August 12, 2021 Peer-review started: August 12, 2021 First decision: September 2, 2021 Revised: September 8, 2021 Accepted: September 22, 2021 Article in press: September 22, 2021 Published online: November 16, 2021
Abstract
BACKGROUND
Jaundice is a major manifestation of posthepatectomy liver failure, a feared complication after hepatic resection. Herein, we report a case of posthepatectomy jaundice that was not caused by liver failure but by paroxysmal nocturnal hemoglobinuria (PNH)-induced hemolysis.
CASE SUMMARY
A 56-year-old woman underwent right hepatectomy and biliary tract exploration surgery due to hepatic duct stones. Prior to surgery, the patient was mildly anemic. The direct antiglobulin test was negative. A bone marrow biopsy showed mild histiocyte hyperplasia. After surgery, the patient suffered a progressive increase in serum bilirubin. Meanwhile, the patient developed hemolytic symptoms after blood transfusion. She was ultimately diagnosed with PNH. PNH is a rare bone marrow failure disorder that manifests as complement-dependent intravascular hemolysis with varying severity. After steroid treatment, the patient’s jaundice gradually decreased, and the patient was discharged on the 35th postoperative day.
CONCLUSION
PNH-induced hemolysis is a rare cause of posthepatectomy jaundice. It should be suspected in patients having posthepatectomy hyperbilirubinemia without other signs of liver failure. Steroid therapy can be considered for the treatment of PNH in such cases.
Core Tip: We report a case of posthepatectomy jaundice that was not caused by liver failure but by paroxysmal nocturnal hemoglobinuria-induced hemolysis. After confirming the diagnosis, the patient received steroid therapy, and the jaundice gradually improved.
