Hemolysis in Early Infancy: Still a Cause of Cholestatic Neonatal Giant Cell Hepatitis

Authors

Hao Wu, Department of Pathology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT.
Oya Tugal, Department of Pediatrics, Westchester Medical Center and New York Medical College, New York, NY.Follow
Antonio R. Perez-Atayde, Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA.

Author Type(s)

Faculty

DOI

10.1097/PAS.0000000000001841

Journal Title

The American Journal of Surgical Pathology

First Page

801

Last Page

808

Document Type

Article

Publication Date

6-1-2022

Department

Pediatrics

Abstract

Before the prophylactic use of anti-D antibodies in pregnancy, hemolytic anemia of the newborn was the most common cause of hyperbilirubinemia. Nowadays, given the rarity of hemolytic anemia of the newborn, hepatobiliary abnormalities, perinatal infections, and metabolic disorders have become the most common conditions in the differential diagnosis of neonatal cholestasis. Here, we report 3 instances of cholestatic giant cell hepatitis in 3 infants who had Coombs' positive hemolysis due to ABO incompatibility in 1, Rh incompatibility in another, and combined ABO and Rh incompatibility in the third. Although rare, cholestatic neonatal giant cell hepatitis associated with hemolysis still needs to be considered in patients with neonatal cholestasis. A marked elevation of aspartate aminotransferase over alanine aminotransferase can be a helpful clue to an early diagnosis.

Recommended Citation

Wu, H., Tugal, O., & Perez-Atayde, A. R. (2022). Hemolysis in Early Infancy: Still a Cause of Cholestatic Neonatal Giant Cell Hepatitis. The American Journal of Surgical Pathology, 46 (6), 801-808. https://doi.org/10.1097/PAS.0000000000001841