Hepatitis-associated aplastic anaemia (HAAA) is a potentially fatal condition with no obvious therapeutic options. The study’s objective was to define the presentation, assessment, histology, and results of therapy in children with HAAA in order to guide future research and provide uniform care recommendations for this uncommon illness. A retrospective chart analysis was performed on four kids with HAAA who came to Children’s Hospital Colorado. The following information was gathered: patient presentation, assessment, bone marrow and liver pathology, treatments, and clinical course. Immunohistochemistry was conducted on liver biopsies. Researchers administered HAAA to four individuals who did not develop liver failure. All showed signs of systemic hyperinflammation and predominant CD8+ T cell infiltration of liver tissue. One had a genetic abnormality that made him prone to immune-mediated illness, but all other genetic tests came back negative. Hepatitis was poorly responsive to standard therapy with steroids, azathioprine, or tacrolimus in three of four patients; however, sustained biochemical remission of hepatitis was induced following more aggressive immunosuppressive therapies, including Anti-Thymocyte Globulin at standard immunosuppressive therapy (IST) dosing for severe Aplastic Anemia. A hematopoietic stem cell transplant was performed on two patients, one as first-line therapy and the other as a second-line therapy.

They discovered that ATG-based IST caused hepatitis remission in individuals with steroid-refractory HAAA. They argue that horse ATG-based IST at standard dosage regimen for sAA is a therapy that, in chosen instances, may be explored early in the treatment course and might lead to a prolonged remission of both hepatitis and sAA.

Reference: https://journals.lww.com/jpgn/Abstract/2021/02000/Outcomes_of_Severe_Seronegative.5.aspx