Acute Viral Hepatitis, Glucose-6-Phosphate Dehydrogenase Deficiency, and Hemolytic Anemia

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Abstract
Anemia which occurs in patients with viral hepatitis has been ascribed to transient hypersplenism, ineffective erythropoiesis with bone marrow megaloblastosis, and immune mechanisms.1 More recently, attention has been drawn to glucose-6-phosphate dehydrogenase (G-6-PD) deficiency as an additional potential cause for the anemia sometimes observed in viral hepatitis.2-4 The purpose of this report, therefore, is to describe three patients with this form of liver disease who also had G-6-PD deficiency, to emphasize that the hematologic abnormalities which may occur in this clinical combination are variable, and to outline the factors which may modify the different degrees of observed hemolysis. Patient Summaries Patient 1. —A 29-year-old, previously healthy, Iranian physician was admitted to the Graduate Hospital of the University of Pennsylvania on April 7, 1966, because of generalized myalgia of four days' duration. His major complaint was preceded, in sequence, by a temperature of 102 F (38.9 C), dark urine,

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