Abstract

Case Report

Treatment of autoimmune hemolytic anemia with erythropoietin: A case report

Renato A Guzmán*, Juan P Ovalle, Estefanía M Orozco, Laura C Pedraza, María C Barrera and Dormar D Barrios M

Published: 20 November, 2019 | Volume 3 - Issue 1 | Pages: 043-046

In this article, we describe the case of a fifty-year-old patient with autoimmune hemolytic anemia (AIHA) with constitutional symptoms, jaundice, unquantified fever and progressive dyspnea. The patient had history of smoking and Hepatitis A and following a physical exam she was found in a regular condition, icteric but with no other further signs. Her laboratory tests revealed hemolytic anemia with a hemoglobin of 8.5 g/dL, an increase of total and indirect bilirubin, an elevated ferritin, a decreased transferrin and haptoglobin and a positive result for direct Coomb’s test. Considering this, an immune profile was ordered finding a negative result of ANAs and ENAs and a decrease of complement C3 and C4. The patient was diagnosed with AIHA and as an initial step a corticosteroid treatment was administrated however the patient showed no clinical nor chemical improvement. At her third day of hospitalization, she was unstable hemodynamically requiring transfer to Intensive Care Unit (ICU) to optimize management. After 24 hours on ICU, due to persistence of deterioration of the patient, it was decided to manage with erythropoietin (EPO). In the following days, the patient showed a rise in her hemoglobin and an overall improvement made possible the transfer to hospitalization service. The AIHA is an uncommon disease and is not the first option that comes to mind with these symptoms, currently there are not controlled studies to the treatment due to its complexity and the heterogeneity of the results. We strongly support the use of EPO in refractory cases of this pathology.

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Keywords:

Autoimmune hemolytic anemia; Hematology; Erythropoietin

References

  1. Anemia, Hemolytic, Autoimmune. MeSH. 2019. PubMed: https://www.ncbi.nlm.nih.gov/mesh/68000744
  2. Kalfa TA. Warm antibody autoimmune hemolytic anemia. Hematol Am Soc Hematol Educ Program. 2016; 2016: 690–697. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142448/
  3. Bass GF, Tuscano ET, Tuscano JM. Diagnosis and classification of autoimmune hemolytic anemia. Autoimmun Rev. 2014; 13: 560–564. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24418298
  4. Liebman HA, Weitz IC. Autoimmune Hemolytic Anemia. Med Clin North Am. 2017; 101: 351–359. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28189175
  5. Jaime-Pérez JC, Aguilar-Calderón P, Salazar-Cavazos L, Gómez-De León A, Gómez-Almaguer D. Treatment of autoimmune hemolytic anemia: real world data from a reference center in Mexico. Blood Res. 2019; 54: 131–136. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31309092
  6. Henriquez-Camacho C, Gotuzzo E, Echevarria J, White AC Jr, Terashima A, Samalvides F, et al. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016; 2016: CD007745–CD007745. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26778150
  7. Go RS, Winters JL, Kay NE. How I treat autoimmune hemolytic anemia. Blood. 2017; 129: 2971–2979. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28360039
  8. Salama A. Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review. Transfus Med Hemotherapy Off Organ Dtsch Ges Transfusionsmedizin Immunhamatologie. 2015; 42: 294–301. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678315/
  9. MeSH. 2019. PubMed: https://www.ncbi.nlm.nih.gov/mesh/68004921
  10. Berentsen S, Tjønnfjord GE. Diagnosis and treatment of cold agglutinin mediated autoimmune hemolytic anemia. Blood Rev. 2012; 26: 107–115. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22330255
  11. Berentsen S, Randen U, Tjønnfjord GE. Cold agglutinin-mediated autoimmune hemolytic anemia. Hematol Oncol Clin North Am. 2015; 29: 455–471. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26043385
  12. Zeerleder S. Autoimmune haemolytic anaemia - a practical guide to cope with a diagnostic and therapeutic challenge. Neth J Med. 2011; 69: 177–184. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21527804
  13. Hill QA, Hill A, Berentsen S. Defining autoimmune hemolytic anemia: a systematic review of the terminology used for diagnosis and treatment. Blood Adv. 2019; 3: 1897–1906. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31235526
  14. Naik R. Warm autoimmune hemolytic anemia. Hematol Oncol Clin North Am. 2015; 29: 445–453. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26043384
  15. Brodsky RA. Warm Autoimmune Hemolytic Anemia. N Engl J Med. 2019; 381: 647–654. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31412178
  16. Barcellini W, Fattizzo B, Zaninoni A, Radice T, Nichele I, et al. Clinical heterogeneity and predictors of outcome in primary autoimmune hemolytic anemia: a GIMEMA study of 308 patients. Blood. 2014; 124: 2930–2936. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25232059
  17. Arbach O, Funck R, Seibt F, Salama A. Erythropoietin May Improve Anemia in Patients with Autoimmune Hemolytic Anemia Associated with Reticulocytopenia. Transfus Med Hemotherapy Off Organ Dtsch Ges Transfusionsmedizin Immunhamatologie. 2012; 39: 221–223. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22851939
  18. Nairz M, Sonnweber T, Schroll A, Theurl I, Weiss G. The pleiotropic effects of erythropoietin in infection and inflammation. Microbes Infect. 2012; 14: 238–246. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278592/
  19. Haley K. Congenital Hemolytic Anemia. Med Clin North Am. 2017; 101: 361–374. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28189176
  20. Balestracci A, Martin SM, Toledo I, Alvarado C, Wainsztein RE. Early erythropoietin in post-diarrheal hemolytic uremic syndrome: a case-control study. Pediatr Nephrol Berl Ger. 2015; 30: 339–344. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25138373

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