AN IDIOPATHIC CASE OF COMBINED WARM AND COLD AIHA
- Nuno V. Vieira e Brito, Portugal
Abstract
Background and Aims
Autoimmune hemolytic anemia (AIHA) is usually either warm or cold. In some rare cases patients present with both autohemagglutinins. In this text authors report a case of a male presenting with idiopathic combined warm and cold AIHA which had complete resolution of the anemia following treatment with corticosteroids
Methods
An 81-year-old male was referred to the emergency department (ED) by his primary care physician for asthenia, vomiting, upper abdominal pain and darkened urine in the past 2 months
Results
He presented hemoglobin of 7,1g/dL, leukocytosis, hyponatremia increased total bilirubin. Urine elevated urobilinogen. Worsening anemia with hemoglobin 5,4 g/dL, thrombocytosis, increased LDH and total bilirubin and unmeasurable haptoglobin. Peripheral blood smear showed anisocytosis. Positive DAT test (IgG1/IgG3 and C3d positive) without specificity and cold antibody, anti-I specific with 16 titer. Secondary causes wielded positive serologies for Chlamydia Pneumoniae. Serum protein electrophoresis demonstrated slight polyclonal hypergammablobulinemia, immunofixation demonstrated slight oligoclonal profile with increased lambda chains, urine immunofixation without Bence-Jones protein. No other test results were altered including normal bone marrow biopsy and autoimmune screening. Prednisolone was administered with resolution of hemolysis. At 4 weeks no increase in titer was noted on C. Pneumoniae serologies and presents resolution of hemolysis under no treatment.
Conclusions
An increasing number of mixed or combined warm and cold AIHA cases have been reported in the last few decades. Patients presenting with this disease have been described as severely anemic and having very good response to corticosteroid therapy. In accordance we report another case in which an idiopathic form of this rare disease presented itself in our practice.