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    Autoimmune Hemolytic Anemia CASE STUDY

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    Abdul Quyyum
    A 51-year-old female presented with fatigue, weakness, and shortness of breath. Her hemoglobin was found to be severely low at 4.2 mg/dL. Physical exam revealed she appeared pale. Laboratory tests showed an elevated reticulocyte count. She was diagnosed with autoimmune hemolytic anemia (AIHA) based on a positive direct Coombs' test. In AIHA, autoantibodies attack and destroy red blood cells. She was treated with steroids to suppress the autoimmune response causing the hemolysis.

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    Autoimmune Hemolytic Anemia CASE STUDY

    Uploaded by

    Abdul Quyyum
    473 views4 pages
    A 51-year-old female presented with fatigue, weakness, and shortness of breath. Her hemoglobin was found to be severely low at 4.2 mg/dL. Physical exam revealed she appeared pale. Laboratory tests showed an elevated reticulocyte count. She was diagnosed with autoimmune hemolytic anemia (AIHA) based on a positive direct Coombs' test. In AIHA, autoantibodies attack and destroy red blood cells. She was treated with steroids to suppress the autoimmune response causing the hemolysis.

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    Autoimmune Hemolytic Anemia CASE STUDY

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    A 51-year-old female presented with fatigue, weakness, and shortness of breath. Her hemoglobin was found to be severely low at 4.2 mg/dL. Physical exam revealed she appeared pale. Laboratory tests showed an elevated reticulocyte count. She was diagnosed with autoimmune hemolytic anemia (AIHA) based on a positive direct Coombs' test. In AIHA, autoantibodies attack and destroy red blood cells. She was treated with steroids to suppress the autoimmune response causing the hemolysis.

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    Download as doc, pdf, or txt
    473 views4 pages

    Autoimmune Hemolytic Anemia CASE STUDY

    Uploaded by

    Abdul Quyyum
    A 51-year-old female presented with fatigue, weakness, and shortness of breath. Her hemoglobin was found to be severely low at 4.2 mg/dL. Physical exam revealed she appeared pale. Laboratory tests showed an elevated reticulocyte count. She was diagnosed with autoimmune hemolytic anemia (AIHA) based on a positive direct Coombs' test. In AIHA, autoantibodies attack and destroy red blood cells. She was treated with steroids to suppress the autoimmune response causing the hemolysis.

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    Autoimmune Hemolytic Anemia

    Anemia with Hemoglobin 4.2 mg/dL. What is the Cause?


    Author: A. Rajaminackam, M.D., Department of Hospital Medicine at Cleveland Clinic
    Reviewer: V. Dimov, M.D.
    A 51-year-old female has had fatigue, weakness, and SOB with exertion during the past
    4-5 days. She called her PCP who recommended she had hemoglobin checked. He called
    her back with the results, and told her to go to the ER for further treatment of severe
    anemia. The patient denied abdominal pain, chest pain, congestion, N/V/D/C, dysuria,
    headache, chills, hemoptysis, neck pain, rash, or sore throat.
    Symptoms were exacerbated by activity and relieved by rest and laying supine. She also
    felt palpitations intermittently.
    Past Medical History (PMH)
    DM2.
    Medications
    Lantus (Insulin Glargine, rDNA origin) 25 mg SQ QHS, Humalog (insulin lispro) SSI SQ
    with Accu-Chek Blood Glucose Monitoring TID.
    Physical Examination
    VS: mild tachycardia, no hypotension.
    General appearance: pale, non-icteric.
    Eyes: EOMI, PERRLA, sclerae non-icteric Definition: When a physician or nurse is
    examining a patient's eyes, PERRLA is an acronym used to describe the look and
    function of the eyes. It stands for:
    Pupils
    Equal
    Round
    Reactive to
    Light and
    Accommodation (which means the ability of the eyes to focus on objects that are
    close up and faraway)
    An eye exam is done to check how someone's nervous system is functioning, especially
    after a head injury or during serious illness. An eye exam would be abnormal if the pupils
    are:
    not of equal size

    not round (misshapen)


    don't change when a light is shined on them (should get smaller)
    don't change when looking at something close or faraway

    EOMI
    Extraocular Movements Intact

    ENT: Oropharynx clear, no plaques or exudates


    Chest: CTA (B)
    CVS: Clear S1S2
    Abd: Soft, NT, ND, +BS
    Ext.: no c/c/e
    Neurologic: AAA x 3
    No lymphadenopathy
    What is the most likely diagnosis?
    Severe anemia that is symptomatic with fatigue and shortness of breath (SOB).
    What are the likely causes of anemia in this patient?
    Blood loss?
    Hemolytic anemia?
    Iron-deficiency?
    What laboratory workup would you order?
    CBC+Diff
    CMP
    Reticulocyte count
    LDH
    Haptoglobin
    Peripheral smear
    What happened?
    Hemoglobin (Hgb) was 4.2 mg/dL, MCV 144 fl, reticulocyte count 41%. The patient
    most likely has hemolytic anemia.
    What other tests would you order?
    Direct and indirect Coombs' test
    ANA, RF

    C3, C4
    CXR
    CT c/a/p (chest, abdomen and pelvis)

    CBC and CMP

    Immunology tests
    What happened next?
    The patient was admitted to a regular medical floor and a hematology consult was called.
    The direct Coombs' test was reported as positive.
    CXR and CT scans were negative for neoplastic disease.
    The patients has autoimmune hemolytic anemia (AIHA) mediated by warm antibodies
    because the hemolysis is observed at normal body temperature. By contrast, in the cold
    antibody AIHA, the autoantibodies attack the red blood cells only at temperatures
    significantly below normal body temperature, e.g. when working outside in the winter.
    Would you transfuse this patient?
    The hemoglobin was 4.2 mg/dL and if the patient was symptomatic. A blood transfusion
    was indicated.
    In general, it may be difficult to find compatible blood in AIHA because of the presence
    of autoantibodies. RBC transfusions are generally avoided unless absolutely necessary.
    How would you treat this patient?
    Solu-Medrol (methylprednisolone) 100 mg IV q 6 hr.
    Consider immune globulin infusion.
    Follow-up on the Hem/Onc recommendations.

    Hemoglobin response to steroid treatment in AIHA. Taper glucocorticoids very gradually


    to avoid a relapse of hemolysis.

    Final diagnosis
    Warm Antibody Autoimmune Hemolytic Anemia (AIHA)
    References

    Coombs' test (click to enlarge the diagram). Source: A. Rad. GNU Free Documentation
    License. Wikipedia.
    Hemolytic Anemia. eMedicine.
    Autoimmune Hemolytic Anemia. Merck Manual.
    Seasonal Hemolysis Due to Cold-Agglutinin Syndrome. Lyckholm L. J., Edmond M. B.
    N Engl J Med 1996; 334:437, Feb 15, 1996. Images in Clinical Medicine.

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