scholarly journals Cold agglutinin-associated hemolytic anemia due to brucellosis: First case report

2008 ◽  
Vol 83 (8) ◽  
pp. 685-686 ◽  
Author(s):  
Edgard Wehbe ◽  
Thomas A. Moore
Keyword(s):  
Case Report ◽  
Hemolytic Anemia ◽  
Cold Agglutinin ◽  
First Case

Late Occuring Severe Autoimmune Hemolytic Anemia in a Liver Transplanted Child.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4025-4025
Author(s):  
Hulya Ozsahin ◽  
Michela Schaeppi ◽  
Thierry Peyrard ◽  
Fabienne Gumy-Pause ◽  
Klara Posfay-Barbe ◽  
...  
Keyword(s):  
Case Report ◽  
Liver Transplant ◽  
Lymphoproliferative Disease ◽  
Direct Antiglobulin Test ◽  
Cold Agglutinin ◽  
Reference Laboratory ◽  
Solid Organ ◽  
First Case ◽  
Thermal Amplitude ◽  
Antiglobulin Test

Abstract INTRODUCTION Autoimmune haemolytic anaemia (AIHA) can complicate solid organ as well as bone marrow transplantation both in children and adults. We describe the first case report of a child with AIHA due to mixed type warm-acting IgM and warm IgG auto-antibodies, 8 months after liver transplantation. CASE REPORT A sixteen-month old boy (A Rh D positive blood group,), 8 months after an orthotopic liver transplant (full cadaveric liver, male A Rh D negative) presented with fever and moderate hepatitis. Two weeks after this episode he developed severe anemia with a Hb level of 39 g/L. His red cells were A1 Rh(D) positive. Plasma testing could not be interpreted due to positive reactions with all test cells. Screening for irregular antibodies was positive. The direct antiglobulin test was repeatedly negative. Further analysis revealed a cold agglutinin with low titre (8 at 15°C) but high thermal amplitude (22–37°C) although of IgM nature, and the absence of any underlying alloantibodies. Only Rh null red blood cells were not agglutinated by the autoantibody. Therapy included keeping body temperature over 37° C, transfusions of A Rh(D) positive warmed crossmatched blood units, intravenous immunoglobulins (1g/kg/d x 5 days), and methylprednisolone (20 mg/kg/d). Tacrolimus was replaced by cyclosporin A. Further investigations revealed panagglutinating IgG autoantibodies in the plasma and on the erythrocytes and the monospecific direct antiglobulin test became positive for IgM, IgG, C3c and C3d. French National Reference Laboratory for Immuno-Hematology and Rare Blood Groups confirmed these findings and showed both the IgM and IgG autoantibodies to be directed against the Rh proteins (anti-RH29 antibody) and to be strongly active at 37°C. Crossmatched group O Rh(D) positive red blood cell (RBC) units were transfused, however with limited effect and progressive haemolysis. Hb level dropped to 33 g/L. One cryopreserved O Rh null RBC unit was obtained from the French National Rare Blood Bank. Rituximab® (375 mg/m2 once weekly) (anti-CD 20 monoclonal antibody) was also introduced. Immediately following this transfusion and 24 hours after the first dose of rituximab, Hb levels increased and were stable at 80 g/L. No further transfusions were needed and the haemolytic parameters normalized slowly. Total 4 doses of rituximab were administered.Ten weeks after admission, the child could be discharged. At 18 months’ follow-up, there is no recurrence of AIHA. DISCUSSION Only few cases of AIHA due to warm acting “cold” agglutinins have been described, generally resulting in death. AIHA in patients with liver transplant has been previously reported, mainly due to warm autoantibodies or to classical cold agglutinin disease associated with viral infections, lymphoproliferative disease or autoimmune disorders. Our case is interesting in that this unusual AIHA occurred not only in a liver transplanted child, but also late after transplantation. Although extensive investigations revealed no aetiology, the hypothesis of a viral infection-triggered AIHA with first an IgM, then a mixture of IgM and IgG autoantibodies directed against the same epitope is plausible. This case illustrates the efficacy of rituximab in AIHA not responding to first-line therapy and the importance of international collaboration to provide extremely rare compatible blood units.

scholarly journals First Case of Autoimmune Hemolytic Anemia Associated With COVID-19 Infection in Sri Lanka: A Case Report

Cureus ◽  
2021 ◽  
Author(s):  
Vaishnavi Arunpriyandan ◽  
Somasuriyam Kumanan ◽  
Mayurathan Pakkiyaretnam
Keyword(s):  
Case Report ◽  
Sri Lanka ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
First Case

scholarly journals G6Pd deficiency with severe hemolytic anemia: a case report

2021 ◽  
pp. 79-80
Author(s):  
Zahoor Hussain Daraz ◽  
Dr. Berkheez Shabir ◽  
Dr Rehana Afshan ◽  
Dr Pramesh Kumar Yadav ◽  
Dr. Mohamed Rashwan Meselhy Shady
Keyword(s):  
Case Report ◽  
Hemolytic Anemia ◽  
Serum Bilirubin ◽  
Stable Condition ◽  
Cervical Lymphadenopathy ◽  
Hemoglobin Concentration ◽  
Hemoglobin Level ◽  
Blood Picture ◽  
First Case ◽  
Fava Beans

A 3-year-old boy presented to our atoll hospital in H.A Alif Dhidhoo, with severe pallor, jaundice, easy fatigability and recurrent episodes of passage of dark-colored urine for past 3 days. He was born mature at 39 weeks of gestation with no past significant medical history. Recent history revealed the consumption of 2 cans of fava beans and application of some medicinal herbs. On admission, physical examination revealed fever of 101 degree Fahrenheit, severe pallor, jaundice, cervical lymphadenopathy and mild hepatomegaly. Laboratory investigation results showed a hemoglobin level of 5.4 g/dl with a hemolytic blood picture and serum Bilirubin of 6mg/dl. The patient's G6PD level was measured which showed marked deficiency. Other causes of hemolytic anemia were excluded. Patient required urgent packed RBC transfusion and antibiotics for infection. He responded well to the treatment and was discharged in a stable condition. Parents were appropriately advised on the condition and the importance of avoiding certain foods and medication. Folic acid was prescribed for maintaining normal hemoglobin concentration. This is a first case report in North Maldives of G6PD presenting with severe hemolytic anemia requiring blood transfusion.

Rituximab as Successful Therapy in a Patient with Refractory Paroxysmal Cold Hemaglobinuria.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3730-3730
Author(s):  
Ahrin B. Koppel ◽  
Stephen W. Lim ◽  
Melanie Osby ◽  
George Garratty ◽  
Dennis Goldfinger
Keyword(s):  
Case Report ◽  
Medical Center ◽  
Oral Prednisone ◽  
Single Agent ◽  
Hemoglobin Concentration ◽  
Cold Agglutinin ◽  
Igg Antibody ◽  
Syphilis Infection ◽  
Cold Temperatures ◽  
First Case

Abstract Background: Paroxysmal cold hemaglobinuria (PCH) is caused by an IgG autoantibody which behaves as a biphasic hemolysin, attaching to RBCs at cold temperatures and activating complement at warmer temperatures, leading to hemolysis. This antibody, known as the Donath-Landsteiner antibody (DL-A), frequently shows specificity for the P-antigen. PCH was historically associated with syphilis infection. More recently, the DL-A has been found primarily in children with acquired autoimmune hemolytic anemia (AIHA) following a viral illness. In adults, PCH is rare and may occur as an idiopathic disease or in association with a lymphoproliferative disorder. Cases in children usually resolve spontaneously, whereas the adult form can be chronic and pose a therapeutic challenge, since treatment with steroids and splenectomy may be ineffective. Recently rituximab has been demonstrated to be a useful agent in treating AIHA that is resistant to conventional therapies. Case Report: A 64-year-old woman presented to another hospital with three months of progressive weakness. She was found to be severely anemic. Gastrointestinal blood loss was ruled out. Extensive work up was obtained with CT imaging and bone marrow biopsy, which showed no evidence of malignancy. A hemolytic process was identified and she was placed on oral prednisone 60mg daily. The patient then presented to Cedars-Sinai Medical Center three months later with recurrent fatigue and a hemoglobin concentration (Hb) of 6.6 g/dL. Lab values revealed an elevated reticulocyte count (7.9%), WBC 27.6, total bilirubin 3.5 mg/dL, indirect fraction 3.4 mg/dL, elevated LDH 445 U/L, absent haptoglobin, and microspherocytes on peripheral blood smear. The Direct Antiglobulin (Coombs) Test (DAT) was positive with an anti-complement reagent and negative with an anti-IgG reagent, leading to the suspicion of a DL-A or cold agglutinin. Cold agglutinin titer was normal. A Donath-Landsteiner test was positive, confirming the diagnosis of PCH. Steroids were rapidly tapered and she was given rituximab 375 mg/m2. Her Hb increased and evidence of hemolysis ceased. The patient received 3 additional doses of rituximab weekly. Her Hb recovered to normal. The patient did well for 9 months until she presented again with acute hemolysis (Hb 8.8 g/dL.) The DAT was again positive with an anti-complement reagent and negative with an anti-IgG reagent. She was given a single dose of rituximab with cessation of hemolysis. She received another 3 doses, which resulted in stabilization of her Hb. She remains well at 6 months follow-up. Discussion: The most frequent form of AIHA is due to a warm, IgG antibody and is commonly responsive to steroids or splenectomy, whereas in cold agglutinin disease, caused by an IgM antibody these therapies are usually ineffective. The use of rituximab has been reported as a useful treatment for both warm and cold AIHA refractory to conventional therapy. This is the first case report to our knowledge of a patient with adult PCH refractory to steroids successfully treated with rituximab. This patient responded dramatically to rituximab on two separate occasions, and has remained in remission since the second cycle after treatment with this single agent. Rituximab may represent an effective therapy for adult patients with chronic PCH.

scholarly journals P.077 Mixed autoimmune hemolytic anemia: an unusual cause of ischemic stroke and extensive cerebral microbleeds

2021 ◽  
Vol 48 (s3) ◽  
pp. S41-S41
Author(s):  
M Wan ◽  
A Ganesh ◽  
C Grassi ◽  
A Demchuk
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Cerebral Microbleeds ◽  
Severe Hypoxia ◽  
Amyloid Angiopathy ◽  
Prothrombotic State ◽  
Neurologic Deficits ◽  
First Case

Background: Mixed autoimmune hemolytic anemia (mAIHA) is a rare autoimmune disorder that results in hemolysis with thrombotic complications like ischemic stroke. This is the first case report of cerebral microbleeds secondary to mAIHA. Methods: A literature review of mAIHA and cerebral microbleeds was conducted using the PubMed and Ovid MEDLINE databases from 1980 to 2021. Results: A 76 year old male with congenital deafness and rheumatoid arthritis presented with diffuse livedo reticularis and abdominal pain. He had fulminant hemolysis with new neurologic deficits and altered mental status. CT/CTA of the head and neck were unremarkable. MR brain revealed extensive cerebral microbleeds and multi-territory ischemic strokes. He was diagnosed with mAIHA, started on pulse methylprednisolone, and had no further microbleeds on follow-up MRI. From his clinical picture, common causes of cerebral microbleeds were ruled out such as cerebral amyloid angiopathy and hypertension. The pathogenesis of his microbleeds may be from concomitant severe hypoxia or a prothrombotic state, both previously reported in the literature. Conclusions: This is the first case report of extensive cerebral microbleeds secondary to mAIHA. When a patient develops acute neurologic deficits in the context of mAIHA, extensive cerebral microbleeds may be present possibly due to concomitant severe hypoxia versus a prothrombotic state.

scholarly journals Cold agglutinin-induced hemolytic anemia as the primary presentation in SLE - A case report

2019 ◽  
Vol 8 (5) ◽  
pp. 1807
Author(s):  
Bijaya Mohanty ◽  
MohammadZeya Ansari ◽  
Pranita Kumari ◽  
Ashok Sunder
Keyword(s):  
Case Report ◽  
Hemolytic Anemia ◽  
Cold Agglutinin ◽  
Primary Presentation

scholarly journals Case Report: Autoimmune Hemolytic Anemia in Chronic Granulocytic Leukemia

Blood ◽  
1967 ◽  
Vol 30 (4) ◽  
pp. 518-521 ◽  
Author(s):  
NORMAN I. MALDONADO ◽  
JENARO HADDOCK ◽  
ENRIQUE PÉREZ-SANTIAGO
Keyword(s):  
Case Report ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Cold Agglutinin ◽  
Chronic Granulocytic Leukemia ◽  
Hemolytic Crisis ◽  
Granulocytic Leukemia

Abstract A patient with chronic granulocytic leukemia developed autoimmune hemolytic anemia. He was found to have a cold agglutinin and a nonspecific warm panagglutinin. Therapy with prednisone appeared to control the hemolytic crisis and did not affect the granulocytic process. The patient died of bronchopneumonia, and at autopsy no other neoplasm was found.

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