Sickle Cell Disease and Viral Hepatitis

A review of patients with hepatitis who were hospitalized over a 7-year period revealed 6 cases with predominantly S hemoglobin and 10 with sickle cell trait. The clinical, laboratory, and liver biopsy pictures in these patients were comparable with findings in patients without sickle cell hemoglobinopathy, whether or not anemia was present. The only significant difference was severe hyperbilirubinemia in patients with sickle cell anemia. The bilirubinemia appears to represent the increased load of red cell breakdown products on an acutely damaged liver and is not an effect of anemia per se or a reflection of underlying liver disease. Biopsy specimens failed to demonstrate intrahepatic sickling as the cause of the acute illness or as a complicating factor. The liver disease of sickle cell anemia, frequently attributed to intrahepatic sickling, may also reflect unrecognized viral hepatitis or its sequels.