{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:52:57Z","timestamp":1791305577852,"version":"4.3.1"},"reference-count":17,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,29]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>An adult male patient in his late teens presented with pruritus, nausea and progressive jaundice after travel to West Africa. He did not get a pre-travel hepatitis A vaccination or malaria chemoprophylaxis. Laboratory testing demonstrated hepatocellular injury with alanine aminotransferase (ALT) 4002\u2009U\/L (reference &lt;60), marked hyperbilirubinaemia (total bilirubin 632\u2009\u00b5mol\/L, reference &lt;20) and a mildly prolonged international normalised ratio (INR). Concurrently, he developed non-immune haemolysis with undetectable haptoglobin, elevated lactate dehydrogenase and reticulocytosis, as well as bite and blister cells on blood film with a negative direct antiglobulin test. Acute hepatitis A virus infection was confirmed and enzymatic testing showed glucose-6-phosphate dehydrogenase deficiency. Haemoglobin electrophoresis also identified sickle cell trait. He improved with supportive care, avoidance of oxidant medications and close monitoring without renal injury or need for transfusion. This case illustrates an approach to jaundice in a returning traveller, the recognition of oxidative haemolysis at the bedside and preventive opportunities.<\/jats:p>","DOI":"10.1136\/bcr-2026-274743","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:05:25Z","timestamp":1791302725000},"page":"e274743","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Hepatitis A-associated oxidative haemolysis in a patient with glucose-6-phosphate dehydrogenase deficiency with co-inherited sickle cell trait"],"prefix":"10.1136","volume":"19","author":[{"given":"Poshika","family":"Dhingra","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paige","family":"Shelemey","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahima","family":"Bhanji","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2026100609051530000_19.10.e274743.1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/s41572-023-00461-2","article-title":"Hepatitis A virus infection","volume":"9","author":"Van Damme","year":"2023","journal-title":"Nat Rev Dis Primers"},{"key":"2026100609051530000_19.10.e274743.2","doi-asserted-by":"crossref","DOI":"10.1111\/jvh.14030","article-title":"Evolution and Impact of Hepatitis A Epidemiology in Europe-Systematic Literature Review of the Last 20\u2009Years","volume":"32","author":"Andani","year":"2025","journal-title":"J Viral Hepat"},{"key":"2026100609051530000_19.10.e274743.3","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1001\/jama.2020.4017","article-title":"Management of Hepatitis A in 2020-2021","volume":"324","author":"Desai","year":"2020","journal-title":"JAMA"},{"key":"2026100609051530000_19.10.e274743.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0332317","article-title":"Hepatitis A in Spain: Evolution of hospitalization in the period 2000-2021","volume":"20","author":"Dom\u00ednguez","year":"2025","journal-title":"PLoS One"},{"key":"2026100609051530000_19.10.e274743.5","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1002\/hep.31645","article-title":"Factors Associated With Hepatitis A Mortality During Person-to-Person Outbreaks: A Matched Case-Control Study-United States, 2016-2019","volume":"74","author":"Hofmeister","year":"2021","journal-title":"Hepatology"},{"key":"2026100609051530000_19.10.e274743.6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/jvh.13902","article-title":"Hepatitis A hospitalisations in the United States and risk factors for inpatient mortality: A nationwide population study, 1998\u20132020","volume":"31","author":"Wasuwanich","year":"2024","journal-title":"J Viral Hepat"},{"key":"2026100609051530000_19.10.e274743.7","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2019000944"},{"key":"2026100609051530000_19.10.e274743.8","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1002\/cpt.3333","article-title":"Medications and Acute Hemolysis in G6PD-Deficient Patients - 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