Autoimmune hemolytic anemia in a patient with systemic lupus erythematosus: a case report
Main Article Content
Keywords
Autoimmune hemolytic anemia, hematology, paleness, systemic lupus erythematosus
Abstract
Introduction: Autoimmune hemolytic anemia (AIHA) is a rare disorder characterized by the destruction of red blood cells due to the presence of autoantibodies that target the patient’s own erythrocytes. Given the increasing incidence of AIHA in cases of systemic lupus erythematosus (SLE) and the urgent need for prompt treatment, accurate diagnostic and therapeutic approaches are essential to achieving favourable clinical outcomes. The aim of this study is to report autoimmune hemolytic anemia in a patient with systemic lupus erythematosus.
Case description: A 38-year-old female patient was referred with a diagnosis of anemia, suspected autoimmune hemolytic anemia (AIHA), and suspected systemic lupus erythematosus (SLE). The patient reported experiencing paleness, which she had noticed for the past month, and a history of blood transfusion at a previous hospital. She also complained of fatigue that had been present for the past nine months.
Conclusion: Knowledge of appropriate diagnostic and therapeutic approaches is essential to prevent misdiagnosis and mistreatment. In this case, it can be concluded that the diagnosis and management of AIHA were carried out in accordance with the hospital's standard operating procedures.
References
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25. Conrad K, Röber N, Andrade LEC, Mahler M. The Clinical Relevance of Anti-DFS70 Autoantibodies. Clin Rev Allergy & Immunol. 2016;52(2):202–16. Available from: http://dx.doi.org/10.1007/s12016-016-8564-5
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27. Hanaoka H, Iida H, Kiyokawa T, Takakuwa Y, Kawahata K. A positive direct Coombs’ test in the absence of hemolytic anemia predicts high disease activity and poor renal response in systemic lupus erythematosus. Lupus. 2018;27(14):2274–8. Available from: http://dx.doi.org/10.1177/0961203318809182
28. Van Rhee JA. Hemolytic Anemia. Physician Assist Clin. 2019;4(3):649–62. Available from: http://dx.doi.org/10.1016/j.cpha.2019.02.012
29. Anić F, Zuvić-Butorac M, Stimac D, Novak S. New classification criteria for systemic lupus erythematosus correlate with disease activity. Croat Med J. 2014;55(5):514–9. Available from: https://pubmed.ncbi.nlm.nih.gov/25358884
30. Ozsoylu S, Berenschot HW. Megadose Methylprednisolone (MDMP) Treatment in a Patient with Autoimmune Hemolytic Anemia (AIHA) Resistant to Conventional Corticosteroid Administration: A Case Report. Turkish J Haematol Off J Turkish Soc Haematol. 2013/06/05. 2013;30(2):194–7. Available from: https://pubmed.ncbi.nlm.nih.gov/24385786
2. Park SH. Diagnosis and treatment of autoimmune hemolytic anemia: classic approach and recent advances. Blood Res. 2016/06/23. 2016;51(2):69–71. Available from: https://pubmed.ncbi.nlm.nih.gov/27382547
3. Salama A. Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review. Transfus Med Hemother. 2015/08/10. 2015;42(5):294–301. Available from: https://pubmed.ncbi.nlm.nih.gov/26696797
4. Grace Boxer LC. Life-Threatening Autoimmune Hemolytic Anemia Treated with Manual Whole Blood Exchange with Rapid Clinical Improvement. J Blood Disord & Transfus. 2013;04(05). Available from: http://dx.doi.org/10.4172/2155-9864.1000163
5. Zanella A, Barcellini W. Treatment of autoimmune hemolytic anemias. Haematologica. 2014;99(10):1547–54. Available from: https://pubmed.ncbi.nlm.nih.gov/25271314
6. Kamesaki T, Toyotsuji Tomonori, Kajii E. Characterization of direct antiglobulin test‐negative autoimmune hemolytic anemia: A study of 154 cases. Am J Hematol. 2012;88(2):93–6. Available from: http://dx.doi.org/10.1002/ajh.23356
7. Kuhn A, Bonsmann G, Anders H-J, Herzer P, Tenbrock K, Schneider M. The Diagnosis and Treatment of Systemic Lupus Erythematosus. Dtsch Arztebl Int. 2015;112(25):423–32. Available from: https://pubmed.ncbi.nlm.nih.gov/26179016
8. Giannotta JA, Fattizzo B, Cavallaro F, Barcellini W. Infectious Complications in Autoimmune Hemolytic Anemia. J Clin Med. 2021;10(1):164. Available from: https://pubmed.ncbi.nlm.nih.gov/33466516
9. Tranekær S, Hansen DL, Frederiksen H. Epidemiology of Secondary Warm Autoimmune Haemolytic Anaemia-A Systematic Review and Meta-Analysis. J Clin Med. 2021;10(6):1244. Available from: https://pubmed.ncbi.nlm.nih.gov/33802848
10. Barcellini W, Zaninoni A, Giannotta JA, Fattizzo B. New Insights in Autoimmune Hemolytic Anemia: From Pathogenesis to Therapy Stage 1. J Clin Med. 2020;9(12):3859. Available from: https://pubmed.ncbi.nlm.nih.gov/33261023
11. Packman CH. The Clinical Pictures of Autoimmune Hemolytic Anemia. Transfus Med Hemother. 2015/09/11. 2015;42(5):317–24. Available from: https://pubmed.ncbi.nlm.nih.gov/26696800
12. Luo OD, Rizzolo A, Pelletier P, Popradi G. Case Report of an Abo-Matched Post-Hematopoietic Stem Cell Transplant-Associated Autoimmune Hemolytic Anemia: A Diagnostic and Therapeutic Challenge [Internet]. Elsevier BV; 2024. Available from: http://dx.doi.org/10.2139/ssrn.5027989
13. Weitz I. Immune-Mediated Hemolytic Anemia [Internet]. Anemia in the Young and Old. Springer International Publishing; 2018. p. 137–45. Available from: http://dx.doi.org/10.1007/978-3-319-96487-4_7
14. Hill A, Hill QA. Autoimmune hemolytic anemia. Hematol Am Soc Hematol Educ Progr. 2018;2018(1):382–9. Available from: https://pubmed.ncbi.nlm.nih.gov/30504336
15. Klein-Gitelman M, Lane JC. Systemic Lupus Erythematosus [Internet]. Textbook of Pediatric Rheumatology. Elsevier; 2016. p. 285-317.e14. Available from: http://dx.doi.org/10.1016/b978-0-323-24145-8.00023-5
16. Ardoin SP, Schanberg LE. Systemic Lupus Erythematosus [Internet]. Nelson Textbook of Pediatrics. Elsevier; 2011. p. 841-846.e1. Available from: http://dx.doi.org/10.1016/b978-1-4377-0755-7.00152-4
17. Levy DM, Kamphuis S. Systemic lupus erythematosus in children and adolescents. Pediatr Clin North Am. 2012;59(2):345–64. Available from: https://pubmed.ncbi.nlm.nih.gov/22560574
18. Saleh AM, Kurniati N, Syarif BH. Penilaian Aktivitas Penyakit Lupus Eritematosus Sistemik dengan Skor SLEDAI di Departemen Ilmu Kesehatan Anak RSCM. Sari Pediatr. 2016;16(4):292. Available from: http://dx.doi.org/10.14238/sp16.4.2014.292-8
19. Listiyono F, Murni IK, Sumadiono S, Satria CD. Predictors of mortality in children with systemic lupus erythematosus. Paediatr Indones. 2019;59(1):1–6. Available from: http://dx.doi.org/10.14238/pi59.1.2019.1-6
20. Almeida F, Barros G, Cogo Destefani A. SLICC 12 Criteria Are More Effectiveness than ACR 97 Score about Systemic Lupus Erythematosus Diagnosis. Nucl Recept Res. 2019;6. Available from: http://dx.doi.org/10.32527/2019/101440
21. Zapata L, Chong BF. Exclusion of Cutaneous Lupus Erythematosus Subtypes From the 2019 European League Against Rheumatism/American College of Rheumatology Classifi cation Criteria for Systemic Lupus Erythematosus: Comment on the Article by Aringer et al. Arthritis & Rheumatol. 2020;72(8):1403–4. Available from: http://dx.doi.org/10.1002/art.41296
22. Idborg H, Eketjäll S, Pettersson S, Gustafsson JT, Zickert A, Kvarnström M, et al. TNF-α and plasma albumin as biomarkers of disease activity in systemic lupus erythematosus. Lupus Sci Med. 2018;5(1):e000260–e000260. Available from: https://pubmed.ncbi.nlm.nih.gov/29955370
23. Correa-Rodríguez M, Pocovi-Gerardino G, Callejas-Rubio J-L, Ríos Fernández R, Martín-Amada M, Cruz-Caparros M-G, et al. Dietary Intake of Free Sugars is Associated with Disease Activity and Dyslipidemia in Systemic Lupus Erythematosus Patients. Nutrients. 2020;12(4):1094. Available from: https://pubmed.ncbi.nlm.nih.gov/32326626
24. Chiewchengchol D, Murphy R, Edwards SW, Beresford MW. Mucocutaneous manifestations in juvenile-onset systemic lupus erythematosus: a review of literature. Pediatr Rheumatol Online J. 2015;13:1. Available from: https://pubmed.ncbi.nlm.nih.gov/25587243
25. Conrad K, Röber N, Andrade LEC, Mahler M. The Clinical Relevance of Anti-DFS70 Autoantibodies. Clin Rev Allergy & Immunol. 2016;52(2):202–16. Available from: http://dx.doi.org/10.1007/s12016-016-8564-5
26. Nashi RA, Shmerling RH. Antinuclear Antibody Testing for the Diagnosis of Systemic Lupus Erythematosus. Med Clin North Am. 2021;105(2):387–96. Available from: http://dx.doi.org/10.1016/j.mcna.2020.10.003
27. Hanaoka H, Iida H, Kiyokawa T, Takakuwa Y, Kawahata K. A positive direct Coombs’ test in the absence of hemolytic anemia predicts high disease activity and poor renal response in systemic lupus erythematosus. Lupus. 2018;27(14):2274–8. Available from: http://dx.doi.org/10.1177/0961203318809182
28. Van Rhee JA. Hemolytic Anemia. Physician Assist Clin. 2019;4(3):649–62. Available from: http://dx.doi.org/10.1016/j.cpha.2019.02.012
29. Anić F, Zuvić-Butorac M, Stimac D, Novak S. New classification criteria for systemic lupus erythematosus correlate with disease activity. Croat Med J. 2014;55(5):514–9. Available from: https://pubmed.ncbi.nlm.nih.gov/25358884
30. Ozsoylu S, Berenschot HW. Megadose Methylprednisolone (MDMP) Treatment in a Patient with Autoimmune Hemolytic Anemia (AIHA) Resistant to Conventional Corticosteroid Administration: A Case Report. Turkish J Haematol Off J Turkish Soc Haematol. 2013/06/05. 2013;30(2):194–7. Available from: https://pubmed.ncbi.nlm.nih.gov/24385786