Hyperhemolysis in the Setting of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19

Abstract Introduction: Anemia is a common problem in patients with inflammatory bowel diseases (IBD), and its etiology is usually multifactorial. It can be produced by chronic blood loss, nutritional deficiencies, and drugs such as salazopyrine; however it can also due to auto immune hemolysis, which is a rare complication of IBD. We report a case of coombs positive autoimmune hemolytic anemia associated with ulcerative colitis both diagnosed at the same presentation. Case Report: A 32 year old man with no significant past medical history presented with complaint of dark colored urine, jaundiced skin and fatigue for 4 weeks. He also reported diarrhea mixed intermittently with blood for last few months. Physical exam was consistent with jaundice and anemia (pallor and icterus) with slightly palpable spleen. Initial lab work up showed Hb of 3.8 with normal platelet and WBC count, high reticulocytes count of 7% .LFT showed serum bilirubin of 3.6 (direct 0.4) with normal serum ALT and AST levels .Serum LDH was high (1032 U/l) while serum haptoglobin was low (0.11 mg/dl). Peripheral smear showed anisopoikilocytosis & spherocytosis. (See Figure 1) Further investigations revealed a positive direct Coombs test consistent with diagnosis of autoimmune hemolytic anemia. CT abdomen and pelvis showed mild splenomegaly & non-specific enlarged mesenteric lymph nodes. Colonoscopy revealed ulcerative pancolitis confirmed by histological findings of biopsies taken. Patient received PRBC transfusions and was started on steroids and mesalamine and was discharged on maintenance dose. His symptoms resolved in 4 weeks and Hb remained stable with no evidence of further hemolysis at 4 month follow up .Repeated CT abdomen & pelvis showed resolution of the lymphadenopathy. Figure 1: Peripheral Blood smear showing anisopoikilocytosis & spherocytosis. Figure 1:. Peripheral Blood smear showing anisopoikilocytosis & spherocytosis. Discussion: Autoimmune hemolytic anemia (AIHA) is a rare complication of IBD. The exact underlying pathogenesis of this association remains obscure; however it has been attributed to the production of cross reacting anti erythrocyte antibodies. In AIHA associated with IBD, corticosteroids are considered to be first line therapy and often cause remission of hemolysis along with treatment for IBD Immunomodulators and splenectomy has been used for patients with refractory AIHA. Colectomy done for fulminant colitis has also been reported to induce remission of AIHA. Further studies for long term follow up and pathogenesis of this association are warranted.

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Sepsis-induced Autoimmune Hemolytic Anemia: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.8.49040 ◽

2020 ◽

Vol 4 (4) ◽

pp. 668-670

Author(s):

Zach Edwards ◽

Stephen DeMeo

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Case Report ◽

Hemolytic Anemia ◽

Patient Outcomes ◽

Autoimmune Hemolytic Anemia ◽

Rare Complication ◽

Signs And Symptoms ◽

Emergency Physicians ◽

Colonic Diverticula

Introduction: Sepsis commonly brings patients to the emergency department (ED). Patient outcomes can vary widely. In some cases, rare complications of sepsis such as autoimmune hemolytic anemia can occur. Case Report: A 68-year-old female presented with sepsis secondary to infected nephrolithiasis. The patient had signs and symptoms consistent with hemolysis upon arrival to the ED. Her hemolysis progressively worsened over a two-day period leading to a diagnosis of warm autoimmune hemolytic anemia. She responded well to treatment; however, her condition began to worsen due to a new infection caused by perforated colonic diverticula. The patient ultimately expired from complications of her perforated colonic diverticula. Conclusion: It is crucial that emergency physicians understand the risk factors, symptoms, pathophysiology, and treatment of this rare complication of sepsis so that favorable patient outcomes can be achieved.

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An Interesting Case of EBV-Associated Autoimmune Hemolytic Anemia

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz117.006 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S87-S88

Author(s):

Sapna Desai ◽

Jeffrey West ◽

Salvador Sena

Keyword(s):

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Cell Function ◽

Hepatitis B Surface Antigen ◽

Rare Complication ◽

Macrocytic Anemia ◽

Interesting Case ◽

Significant Past Medical History ◽

Adequate Treatment ◽

Laboratory Test Results

Abstract We report a case of a 28-year-old male with no significant past medical history who presented with a weeklong history of flu-like symptoms, dark urine, and cold-induced pain and discoloration in his fingers. Upon presentation, he was noted to be significantly jaundiced. Abdominal ultrasound showed splenomegaly. Laboratory test results returned as follows: hematocrit, 26.4%; hemoglobin, 9.0 g/dL; WBC count, 9.8 × 109/L; and automated differential, 0.42 segmented neutrophils, 0.44 lymphocytes, and 0.08 monocytes. Manual differential showed 0.26 atypical lymphocytes, 0.21 lymphocytes, 0.10 monocytes, 0.03 metamyelocytes, and 0.05 segmented neutrophils. He was found to have a normochromic macrocytic anemia with absolute lymphocytosis, monocytosis, and thrombocytopenia. Peripheral blood smear revealed normochromic macrocytic RBCs with anisocytosis. Downey type II cells, plasmacytoid lymphocytes, large activated lymphocytes, and monocytes were present in addition to a neutrophilic left shift up to metamyelocytes. Liver function tests showed elevated levels of total bilirubin (8.4 mg/dL), direct bilirubin (2.6 mg/dL), aspartate aminotransferase (193 U/L), alanine aminotransferase (102 U/L), and alkaline phosphatase (132 U/L). Urinalysis was positive for urobilinogen. Serology was nonreactive for anti–hepatitis A IgM, hepatitis B surface antigen, and anti–hepatitis C antibody. Positive results were obtained for a rapid monoscreening test and Epstein-Barr virus viral capsid antigen IgM. Direct antiglobulin testing showed positivity for IgG, and complement and cold autoantibody were detected. He was transfused and treated with prednisone, IVIG, and external warmth. After improvement, the patient was discharged with recommendations for follow-up. Hemolytic anemia is a relatively rare complication of patients with infectious mononucleosis and occurs in approximately 1% to 3% of these patients. The pathogenesis of EBV-related autoimmune hemolytic anemia is unknown, with a suspicion for inadequate B-cell function after infection. Appropriate laboratory testing and analysis are critical for rapid diagnosis in these patients to ensure adequate treatment with no long-term sequelae.

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Atypical complication in an adult patient with dengue and autoimmune hemolytic anemia: a case report

Asian Biomedicine ◽

10.1515/abm-2021-0006 ◽

2021 ◽

Vol 15 (1) ◽

pp. 43-48

Author(s):

Supat Chamnanchanunt ◽

Pravinwan Thungthong ◽

Chajchawan Nakhakes ◽

Putza Chonsawat ◽

Tawatchai Suwanban

Keyword(s):

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Rare Complication ◽

Dengue Infection ◽

Volume Overload ◽

Factor Vii ◽

Severe Dengue ◽

Severe Bleeding ◽

Bleeding Tendency ◽

Recombinant Activated Factor Vii

Abstract Severe dengue infection is associated with life-threatening complications, including severe bleeding. The bleeding tendency is typically associated with the shock phase of infection, for which blood replacement may be needed. However, repetitive blood transfusion can lead to volume overload. Administration of recombinant activated factor VII (rFVIIa) might be used to counteract bleeding without inducing volume overload. We describe the case of a patient with severe dengue infection who presented with intractable bleeding; he was initially treated with massive blood transfusions, which resulted in volume overload. He was then treated with rFVIIa to reverse the bleeding. During the second week of his hospitalization, his hematocrit dropped precipitously, and autoimmune hemolytic anemia was diagnosed. Supportive treatment was provided until recovery. Autoimmune hemolytic anemia is a rare complication in adult patients with dengue. Supportive care was effective for this atypical complication.

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A rare complication following splenectomy for an autoimmune hemolytic anemia in a child

Journal of Pediatric Surgery ◽

10.1016/0022-3468(95)90726-2 ◽

1995 ◽

Vol 30 (5) ◽

pp. 759

Author(s):

Gunter H Willital

Keyword(s):

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Rare Complication

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Atypical complication in an adult patient with dengue and autoimmune hemolytic anemia: a case report

Asian Biomedicine ◽

10.2478/abm-2021-0006 ◽

2021 ◽

Vol 15 (1) ◽

pp. 43-48

Author(s):

Supat Chamnanchanunt ◽

Pravinwan Thungthong ◽

Chajchawan Nakhakes ◽

Putza Chonsawat ◽

Tawatchai Suwanban

Keyword(s):

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Rare Complication ◽

Dengue Infection ◽

Volume Overload ◽

Factor Vii ◽

Severe Dengue ◽

Severe Bleeding ◽

Bleeding Tendency ◽

Recombinant Activated Factor Vii

Abstract Severe dengue infection is associated with life-threatening complications, including severe bleeding. The bleeding tendency is typically associated with the shock phase of infection, for which blood replacement may be needed. However, repetitive blood transfusion can lead to volume overload. Administration of recombinant activated factor VII (rFVIIa) might be used to counteract bleeding without inducing volume overload. We describe the case of a patient with severe dengue infection who presented with intractable bleeding; he was initially treated with massive blood transfusions, which resulted in volume overload. He was then treated with rFVIIa to reverse the bleeding. During the second week of his hospitalization, his hematocrit dropped precipitously, and autoimmune hemolytic anemia was diagnosed. Supportive treatment was provided until recovery. Autoimmune hemolytic anemia is a rare complication in adult patients with dengue. Supportive care was effective for this atypical complication.

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