Today we presented a case of a patient with hepatitis C presenting with a presumed non-antibody mediated hemolytic anemia with renal failure and hematuria.
We have discussed the vascular and renal complications of Hepatitis C, including cryoglobulinemia and membranoproliferative glomerulonephritis previously. Another good review of crytoglobulinemia and hepatitis C is available here.
Note that hemolysis is not a common feature of this syndrome. It is possible that the anemia is related to GI bleeding, particularly small bleeding caused by mesenteric ischemia from vasculitis. Perhaps this isn't hemolysis, particulary because the bilirubin is not elevated (see approach to hemolysis) even though the haptoglobin is low and the LDH is mildly elevated.
This article reviews 'cold hemolytic anemia' or hemolytic anemia related to IgM mediated antibodies and can be seen occasionaly in cryoglobulinemia.
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