Autoimmune Hemolytic Anemia in Inflammatory Bowel Disease—Report of a Case and Review of the Literature

Abstract

A wide spectrum of extraintestinal manifestations (EIMs) can burden patients with inflammatory bowel disease (IBD). EIMs contribute fairly to morbidity and mortality rates in IBD patients. Moreover, EIMs in IBD patients are so frequent that some suggest that IBD should be approached as a systemic disorder. Anemia is very common in IBD patients. The two most common types of anemia in IBD, iron deficiency anemia and anemia of chronic disease, are extraintestinal complications. Autoimmune hemolytic anemia (AIHA) is a rare extraintestinal manifestation of IBD, more frequent in ulcerative colitis (UC) than in Crohn’s disease (CD). In this case-based review of the literature, we present a 36-year-old female patient diagnosed with Crohn’s disease (CD) and Coombs positive AIHA, complicated by pulmonary thromboembolism and successfully treated with anti-tumor necrosis factor (anti-TNF) therapy. The underlying pathophysiological mechanism of AIHA in IBD is unclear. Treatment options for AIHA in IBD patients before biologic therapy included corticosteroids alone or in combination with azathioprine (AZA), methotrexate, and surgical treatment (colectomy and/or splenectomy). Currently, biologic therapy is a promising therapeutic option, especially in corticosteroid refractory or corticosteroid-dependent IBD patients with AIHA.

Iron Load Toxicity in Medicine: From Molecular and Cellular Aspects to Clinical Implications

“…The re-trafficking of iron is also found in many categories of chronically ill patients with anemia of chronic disease or anemia of inflammation, where the retention of iron in reticuloendothelial cells causes iron-restricted erythropoiesis, low production of hemoglobin, and also anemia. These diseases include cancer and hematological malignancies, infections, inflammatory diseases, immune-mediated diseases, chronic kidney disease, and congestive heart failure ( Table 1 ) [ 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 ]. The treatment of the anemia of chronic disease is very challenging for almost all categories of patients affected and is the subject of research investigations and therapeutic approaches, including, in many cases, the fine balance between iron deficiency level and iron toxicity of administered iron [ 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 ].…”

Autoimmune Haemolytic Anaemia as a Rare and Potentially Serious Complication of Crohn’s Disease in a 11-Year-Old Child—Case Report and Minireview

“…Inflammatory bowel diseases (IBDs) are characterized by chronic inflammation of the intestinal wall and a chronic and recurrent course. The group includes ulcerative colitis (UC) and Crohn's disease (CD) [1][2][3]. The pathogenesis of IBD is not yet fully understood, but its development is known to be influenced by the dysregulation of specific and nonspecific immune responses, environmental factors, gut microbiota and genetic factors [3,4].…”

“…Although IBD is a disease of the gastrointestinal tract, its symptoms are not limited to this system, and it may co-occur with arthropathy, erythema nodosum and primary sclerosing cholangitis (PSC) [4,5]. Various types of extraintestinal complications can also be observed, both as a result of ongoing inflammation and as an adverse effect of the treatments [2]. Up to 50% of IBD patients experience at least one extraintestinal complication, of which up to 24% are detected before the diagnosis of IBD [2,3], and 29% occur for as long as 15 years following the disease [5].…”

“…Various types of extraintestinal complications can also be observed, both as a result of ongoing inflammation and as an adverse effect of the treatments [2]. Up to 50% of IBD patients experience at least one extraintestinal complication, of which up to 24% are detected before the diagnosis of IBD [2,3], and 29% occur for as long as 15 years following the disease [5].…”

Effect of HYD Drugs on Hemolytic Anemia Induced by Phenylhydrazine Hydrochloride

“…For this purpose, it is not appropriate to use any plants with antianemic effect separately, because the required polyvalent pharmacological effect can be achieved only on the basis of a combination of plants. Therefore, Matricaria chamomilla L. Achillea millefolium L., Polygonum Hydropiper L, Polygonum aviculare L, Radix Glycyrrhizae are medicinal plants with polyvalent pharmacological effects and their application in medical practice is of great importance [16,17,18,19,20,21,22].…”