Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.10046
Peer-review started: August 12, 2021
First decision: September 2, 2021
Revised: September 8, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 16, 2021
Processing time: 89 Days and 17.6 Hours
Jaundice is a major manifestation of posthepatectomy liver failure, a feared complication after hepatic resection. Herein, we report a case of posthepatectomy jaundice that was not caused by liver failure but by paroxysmal nocturnal hemoglobinuria (PNH)-induced hemolysis.
A 56-year-old woman underwent right hepatectomy and biliary tract exploration surgery due to hepatic duct stones. Prior to surgery, the patient was mildly anemic. The direct antiglobulin test was negative. A bone marrow biopsy showed mild histiocyte hyperplasia. After surgery, the patient suffered a progressive increase in serum bilirubin. Meanwhile, the patient developed hemolytic symptoms after blood transfusion. She was ultimately diagnosed with PNH. PNH is a rare bone marrow failure disorder that manifests as complement-dependent intravascular hemolysis with varying severity. After steroid treatment, the patient’s jaundice gradually decreased, and the patient was discharged on the 35th postoperative day.
PNH-induced hemolysis is a rare cause of posthepatectomy jaundice. It should be suspected in patients having posthepatectomy hyperbilirubinemia without other signs of liver failure. Steroid therapy can be considered for the treatment of PNH in such cases.
Core Tip: We report a case of posthepatectomy jaundice that was not caused by liver failure but by paroxysmal nocturnal hemoglobinuria-induced hemolysis. After confirming the diagnosis, the patient received steroid therapy, and the jaundice gradually improved.