Autoimmune Hemolytic Anemia: Mixed Type—A Case Report

Reddy, Vardhan; Samayam, Purnima; Ravichander, B; Bai, Uma

doi:10.1007/s12288-011-0065-3

Cited by 12 publications

(10 citation statements)

References 10 publications

(20 reference statements)

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“…In a previous report on warm AIHA patients complicated with SLE, mean Hb at diagnosis was 8.3 ± 1.8 g/dL . In contrast, patients with mixed AIHA have critical and acute hemolysis at onset, as observed in the present patient. According to case reports of adults, most patients with mixed AIHA secondary to SLE have severe anemia: minimum Hb at onset is <6 g/dL .…”

Section: Discussionsupporting

confidence: 66%

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Systemic lupus erythematosus presenting with mixed‐type fulminant autoimmune hemolytic anemia

Hirano

Itonaga

Yasudo

et al. 2016

Pediatrics International

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We report the case of a 9-year-old girl who presented with mixed-type fulminant autoimmune hemolytic anemia (AIHA) at the onset of systemic lupus erythematosus (SLE). On admission, laboratory investigations indicated very severe anemia (Hb, 2.7 g/dL) with reticulocytosis and positive direct/indirect Coombs tests. In addition, agglutinative reaction was clinically observed. Based on further examinations, the patient was diagnosed with AIHA complicated with SLE, and mixed-type AIHA was clinically identified. With oral prednisolone and methylprednisolone pulse therapy, the patient entered remission.

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Section: Discussionsupporting

confidence: 66%

“…Childhood‐onset mixed AIHA is extremely rare. To the best of our knowledge, few cases have been reported in the literature . These cases were commonly characterized by acute onset of severe anemia, with Hb between 2.1 and 4.5 g/dL …”

Section: Discussionmentioning

confidence: 99%

Systemic lupus erythematosus presenting with mixed‐type fulminant autoimmune hemolytic anemia

Hirano

Itonaga

Yasudo

et al. 2016

Pediatrics International

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“…In a more recent case, Reddy et al . ( 12 ) reported elevated MCHC and MCV in a 12-year-old girl with mixed autoimmune hemolytic anemia.…”

Section: Discussionmentioning

confidence: 99%

70-year old female patient with mismatch between hematocrit and hemoglobin values: the effects of cold agglutinin on complete blood count

Ercan¹,

Çalışkan²,

Koptur³

2014

Biochem Med

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Introduction:There are a number of pre-analytical and analytical factors, which cause false results in the complete blood count. The present case identifies cold agglutinins as the cause for the mismatch between hematocrit and hemoglobin values.Materials and methods:70-year old female patient had a history of cerebrovascular diseases and rheumatoid arthritis. During routine laboratory examination, the patient had normal leukocyte and platelet counts; however, the hemoglobin (Hb: 105 g/L) and hematocrit (HCT: 0.214 L/L) results were discordant. Hemolysis, lipemia and cold agglutinin were evaluated as possible reasons for the mismatch between hematocrit and hemoglobin values.Results:First blood sample was slightly hemolysed. Redrawn sample without hemolysis or lipemia was analyzed but the mismatch became even more distinct (Hb: 104 g/L and HCT: 0.08 L/L). In this sample, the titration of the cold agglutinin was determined and found to be positive at 1:64 dilution ratios. After an incubation of the sample at 37°C for 2 hours, reversibility of agglutination was observed.Conclusion:We conclude that cold agglutinins may interfere with the analysis of erythrocyte and erythrocyte-related parameters (HCT, MCV, MCH and MCHC); however, Hb, leukocyte and platelet counts are not affected.

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“…[ 8 ] Mixed AIHA is usually diagnosed when monospecific DAT is positive for warm IgG autoantibody and C3 and cold agglutinins with thermal amplitude >30°C with absence of characteristic features of cold hemagglutinin disease (CHAD). [ 3 4 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] AIHA shows female preponderance (male:female = 1:1.5) and is uncommon in young patients affecting approximately 0.2/100,000 in 11–20 years age group. [ 1 4 5 ] Out of these, <5% are mixed AIHA. [ 6 ]…”

Section: Introductionmentioning

confidence: 99%

Rare presentation of mixed autoimmune hemolytic anemia in children: Report of 2 cases

et al. 2017

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Immune hemolytic anemia is characterized by clinical and laboratory features of hemolytic anemia with direct antiglobulin test (DAT) positivity. It could be autoimmune hemolytic anemia (AIHA), alloimmune, or drug-induced hemolysis based on the antigenic stimulus. Furthermore, based on thermal amplitude of autoantibody, AIHA is classified as warm (65%), cold (30%), and mixed (5%) type. Mixed AIHA is extremely rare in children and must be differentiated from warm AIHA with clinically insignificant cold agglutinins and cold hemagglutinin disease as their treatment is different. It may present as blood group discrepancy or cross-match incompatibility leading to delay in arranging suitable blood unit for transfusion. Therefore, a thorough immunohematology workup including monospecific DAT, indirect antiglobulin test at 4°C and 37°C, determination of thermal amplitude and titer is essential. We hereby present two pediatric cases of mixed AIHA presenting as ABO forward and reverse blood group discrepancy and cross-match incompatibility.

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Autoimmune Hemolytic Anemia: Mixed Type—A Case Report

Cited by 12 publications

References 10 publications

Systemic lupus erythematosus presenting with mixed‐type fulminant autoimmune hemolytic anemia

Systemic lupus erythematosus presenting with mixed‐type fulminant autoimmune hemolytic anemia

70-year old female patient with mismatch between hematocrit and hemoglobin values: the effects of cold agglutinin on complete blood count

Rare presentation of mixed autoimmune hemolytic anemia in children: Report of 2 cases

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