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Severe non-immune mediated haemolytic anaemia (HA) rarely occurs in acute viral hepatitis, unless patients have underlying red cell enzyme abnormalities or pre-existing liver disease. We report such a case and provide a summary of other available cases to date.  Overall, young and fit patients suffering from acute viral hepatitis seem to be affected. Several viral subtypes have been associated, although we report the first hepatitis B and E co-infection case. It seems to occur when patients are recovering from hepatitis and the disease course is variable. The degree of anaemia is always severe, and is inevitably associated with increased morbidity and mortality.  Several theories exist with regard to its aetiology, including the disruption of erythrocyte metabolism. Although its optimal treatment strategies remain unclear, some evidence suggests a possible role for steroid therapy.

Case Report: Severe non-immune mediated haemolytic anaemia associated with acute hepatitis B and E co-infection in a patient with normal G6PD levels