Simultaneous Occurrence of 2009 H1N1 Influenza and Server Acute Hemolytic Anemia —Three Cases

Abstract 5139

Most symptoms of 2009 H1N1 virus patients are mild, and most patients could recover well. Lymphopenia and thrombocytopenia are common in 2009 H1N1 patients. We observed that three patients who suffered from acute severe hemolytic anemia (Hemoglobin<60g/L), two of which(Case 1 and 3) also accompany with thrombocytopenia while suffered from H1N1. Two patients(Case 2and 3)got high fever and dark urine at the same time, and another patient(case1)suffered dark urine two days after cough. All patients were confirmed of H1N1 positive by RT-PCR test, while other lab tests and symptoms were consistent with hemolytic anemia. Two of them (case 2 and 3) progressed into hemolytic uremic syndrome and were treated with hemodialysis and methylprednisolone. Another patient (case 3) had been diagnosed with Paroxysmal nocturnal hemoglobinuria (PNH) for one year, and her hemoglobin had maintained about 110g/L, but lower to 45 g/L when she suffered from 2009 H1N1. All three patients were administrated with oseltamivir (75 mg, twice per day) for 5 days by oral and supportive therapy. The hemoglobin level of two patients (Case 1 and 2) increased to 100 g/L after three weeks gradually, and another PNH patient's hemoglobin returned to between 80 and 90g/L after two months. Our three cases had high fever and dark urine simultaneously, which indicated that 2009 H1N1 influenza may induce acute severe hemolytic anemia. Physicians need to be aware of this complication.