{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:50:50Z","timestamp":1787021450698,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/f1000research.156586.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000}}],"reference-count":30,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Reports from the literature have discussed patients presenting Hepatitis A virus infection with hemolytic anemia, specifically with glucose-6-phosphate dehydrogenase deficiency. However, autoimmune hemolytic anemia (AIHA) has been rarely reported. We present a challenging case of Coombs-negative hemolytic anemia as initial manifestation of hepatitis A virus infection in a silent carrier of \u03b1-thalassemia.<\/ns5:p>","DOI":"10.12688\/f1000research.156586.2","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T05:10:08Z","timestamp":1744693808000},"page":"1224","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Acute hepatitis A virus infection presenting with direct antiglobulin test-negative autoimmune hemolytic anemia and \u03b1-thalassemia trait"],"prefix":"10.12688","volume":"13","author":[{"given":"Habiba","family":"Debbabi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eya","family":"Chakroun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4077-8373","authenticated-orcid":false,"given":"Hajer","family":"Hassine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hela","family":"Kchir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhouha","family":"Cherif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0042-7704","authenticated-orcid":false,"given":"Haythem","family":"Yacoub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Maamouri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"15-19","DOI":"10.1159\/000252779","article-title":"Hepatitis A: clinical manifestations and management.","volume":"53","author":"S Jeong","year":"2010","journal-title":"Intervirology."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1-8","DOI":"10.1155\/2021\/5512883","article-title":"Acute hepatitis A causing severe hemolysis and renal failure in undiagnosed glucose-6-phosphate dehydrogenase deficient patient: A Case Report and Review of the Literature.","volume":"2021","author":"I Abutineh","year":"2021","journal-title":"Case Rep. Hepatol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"670-673","DOI":"10.4103\/ijccm.IJCCM_260_18","article-title":"Hepatitis A virus-induced severe hemolysis complicated by severe glucose-6-phosphate dehydrogenase deficiency.","volume":"22","author":"D Sharma","year":"2018","journal-title":"Indian J. Crit. Care Med."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"204-207","DOI":"10.3350\/cmh.2014.20.2.204","article-title":"Pure red-cell aplasia and autoimmune hemolytic anemia in a patient with acute hepatitis A.","volume":"20","author":"H Chang","year":"2014","journal-title":"Clin. Mol. Hepatol."},{"key":"ref5","first-page":"89-91","article-title":"Immune thrombocytopenic purpura and hemolytic anemia secondary to hepatitis A.","volume":"11","author":"G Miri-Aliabad","year":"2017","journal-title":"Int. J. Hematol.-Oncol. 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Dis."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"611-615","DOI":"10.1007\/BF02774823","article-title":"Acute hemolysis associated with hepatitis A.","volume":"20","author":"K Hara","year":"1985","journal-title":"Gastroenterol. Jpn."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"379-382","DOI":"10.3109\/00365549409008608","article-title":"Hemolysis and autoantibodies to triosephosphate isomerase in a patient with acute hepatitis A virus infection.","volume":"26","author":"K Ritter","year":"1994","journal-title":"Scand. J. Infect. Dis."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"272-275","DOI":"10.1002\/(SICI)1096-9071(199611)50:3<272::AID-JMV10>3.0.CO;2-M","article-title":"Haemolysis in hepatitis A virus infections coinciding with the occurrence of autoantibodies against triosephosphate isomerase and the reactivation of latent persistent Epstein-Barr virus infection.","volume":"50","author":"S Ritter","year":"1996","journal-title":"J. Med. Virol."},{"key":"ref12","first-page":"204-207","article-title":"A case of autoimmune hepatitis and autoimmune hemolytic anemia following hepatitis A infection.","volume":"14","author":"N Urganci","year":"2003","journal-title":"Turk. J. Gastroenterol. Off. J. Turk. Soc. Gastroenterol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"73-75","DOI":"10.1046\/j.1365-2257.1997.00206.x","article-title":"Acute auto immune haemolytic anaemia secondary to hepatitis A infection.","volume":"19","author":"J Tibble","year":"1997","journal-title":"Clin. Lab. Haematol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"38-58","DOI":"10.1128\/CMR.14.1.38-58.2001","article-title":"Hepatitis A: old and new.","volume":"14","author":"J Cuthbert","year":"2001","journal-title":"Clin. Microbiol. 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Sci."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T20:20:12Z","timestamp":1748463612000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":30,"URL":"https:\/\/doi.org\/10.12688\/f1000research.156586.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.156586.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.180216.r379388","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.180216.r379388","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.171914.r332449, Rosy Sultana, Kaiissar Mannoor, Bangladesh University of Health Sciences,, Dhaka, 30 Oct 2024, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/13-1224\/v1#referee-response-332449","order":0,"name":"referee-response-332449","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Hajer Hassine<\/b>; \n<i>Posted: 22 Jan 2025<\/i>; As discussed, we have conducted almost exhaustive investigations to document this hemolysis. However, the use of sequencing of the immunodominant region of the HAV antigen had not been considered. &nbsp;It is accepted in the literature that&nbsp; responsiveness to steroid treatments is considered as a convincing argument in favor of the autoimmune mechanism of hemolysis and a key to establishing a diagnosis of DAT-negative AIHA.  Thank you for the review.","URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2#referee-comment-13196","order":1,"name":"referee-comment-13196","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.171914.r336132, Shiv Sekhar Chatterjee, All India Institute of Medical Sciences, Kalyani, WB, 19 Nov 2024, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/13-1224\/v1#referee-response-336132","order":2,"name":"referee-response-336132","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Hajer Hassine<\/b>; \n<i>Posted: 22 Jan 2025<\/i>; 1.&nbsp;Biliary Magnetic Resonance Imaging (MRI)  3.&nbsp;For spherocytosis: since peripheral red blood cell morphology examinations, are not sufficiently sensitive or specific. An erythrocyte osmotic fragility test (OFT) was conducted. Unfortunately, Eosin\u20105'\u2010maleimide (EMA) binding test (EMABT) and ektacytometry are not carried out here. &nbsp;Howerver, G6PD deficiency was excluded by G6PD level determination. For both, &nbsp;there was no family&nbsp; history of inherited hemolytic anemia.  4.&nbsp;Flow cytometry is performed in the hematology laboratory of the Pasteur Institute of Tunis. We do not have the acquisitions of the graphs when the search for a deficit in GPI-anchored molecules is negative.  5.&nbsp;During hemolysis, folates decrease. It is true that vitamin B9 therapy was prescribed but the patient was not perfectly compliant.  6.&nbsp;Unfortunately, haptoglobin is a parameter that is not always available in our hospital.  7.&nbsp;Other platelet counts were normal during follow-up and well before the initiation of corticosteroid therapy in this patient. Therefore, Evans syndrome was not considered as a differential diagnosis.  8. Hepatic cytolysis could explain the hyperferritinemia which remains &lt; 1000 \u03bcg\/L  9.&nbsp;As discussed, we have conducted almost exhaustive investigations to document this hemolysis.&nbsp;It is accepted in the literature that responsiveness to steroid treatments is considered as a convincing argument in favor of the autoimmune mechanism of hemolysis and a key to establishing a diagnosis of DAT-negative AIHA.  10.&nbsp;capillary electrophoresis was performed. PCR is not systematically done for the diagnosis of Alpha Thalassemia trait here.  Thank you for the review.","URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2#referee-comment-13197","order":3,"name":"referee-comment-13197","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.180216.r379388, Mhd Kutaiba Albuni, TriHealth Good Samaritan Hospital, Cincinnati, Ohio, 29 May 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-1224\/v2#referee-response-379388","order":4,"name":"referee-response-379388","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}