A Five-Month-Old Infant With Severe Autoimmune Hemolytic Anemia Treated Without Blood Transfusions

Abstract

Autoimmune hemolytic anemia (AIHA) is a rare hematologic disease in children with an incidence of 0.2/100,000 under 20 years of age. This article reports the case of an infant with AIHA in which blood transfusions were not necessary, and performs a brief literature review of this rare disease in children. A 5-month-old infant was with a 9-day fever, progressive and intense pallor, severe hepatosplenomegaly, anicteric, and a history of blood incompatibility in cross-tests. Complementary exams showed hemoglobin 3.3 g/dL with reticulocytosis and erythroblastosis, leukocytosis with left upper shift, elevated lactic dehydrogenase, Coombs direct reactive with predominance of IgG. The child evolved with important improvement after pulse methylprednisolone therapy and treatment with folic acid and ceftriaxone, without performing any blood transfusion. The clinical features of AIHA include anemic and hemolytic signs. Mainly, diagnosis is done by laboratory tests showing anemia, hemolysis and positive direct antibody test. In children, it tends to an acute course and to an excellent response to corticosteroids, but erythrocytes transfusions are often used in critical hemoglobin levels.




J Med Cases. 2018;9(9):284-286
doi: https://doi.org/10.14740/jmc3019w