Mixed‐Type Auto‐Immune Haemolytic Anaemia in a Patient with HIV Infection

Abstract

A young HIV-infected patient presented with a severe auto-immune haemolytic anaemia with both warm and cold auto-antibodies, an infrequent category of anti-erythrocyte auto-immunity. Serological findings were compatible with the presence of a low-titre, high-thermal-amplitude anti-I cold-reacting antibody and a pan-reactive warm-reactive auto-antibody. Immunochemical characterisation of the warm antibody failed to identify any membrane protein acting as auto-antigen. This is, to our knowledge, the first reported case of mixed-type auto-immune haemolytic anaemia in a patient with HIV infection. Overt haemolysis is a very rare complication in HIV-infected patients, despite the high prevalence of a positive direct antiglobulin test reported in these patients. This suggests that HIV infection is a condition in which anti-erythrocyte auto-immunity is a serological finding without haemolytic effects in the large majority of cases.

Prevalence of HIV-related autoimmune haemolytic anaemia in Lagos, Nigeria

“…The prevalence of positive DAT of 0.6% (2 of 350) found in this study is in contrast with previous studies by De Angelis et al , and Koduri et al , who reported the prevalence of positive DAT in HIV-infected patients ranges between 18 and 43% 1011…”

“…Furthermore, that these two subjects were above the age of 40 years, and have a low reticulocyte count may be as a result of decreased erythropoiesis that occurs with increasing age. Since the two subjects also had severe immunosuppression (CD4 + cell count <200 cells/μl), it may also be due to bone marrow hypoplasia seen primarily in patients with advanced stages of HIV infection 10. However, though the two subjects had severe immunosuppression, we found no statistical significant association between DAT and CD4 + cell count in this study.…”

“…The rare occurrence may be due to the fact that acquired autoimmune disorders are not common in many parts of Africa and according to Salawu and Durosinmi (2002), Africans that develop autoimmune diseases may have hereditary predisposition 8. This view was also supported by Volberding et al 9 and Olayeni et al who reported a frequency of 3.06% in Benin City, Nigeria 10…”

“…Reports from Africa had shown that AIHA is very rare 8910. The rare occurrence may be due to the fact that acquired autoimmune disorders are not common in many parts of Africa and according to Salawu and Durosinmi (2002), Africans that develop autoimmune diseases may have hereditary predisposition 8.…”

Mixed-Type Autoimmune Hemolytic Anemia following Fludarabine Treatment in a Patient with Chronic Lymphocytic Leukemia&sol;Small Cell Lymphoma

“…Other cases of mixed-type AIHA have been described [2, 3, 4, 5, 6]. They are reported to account for approximately 6–8% of all AIHAs [1, 3, 4].…”