TRANSFUSION IN COLD AUTOIMMUNE HAEMOLYTIC ANAEMIA – A BALANCING ACT. (February 2015)

• Record Type: Journal Article
• Authors: Ling, Victoria; Davis, Mandy
• Is Part Of: Pathology. Volume 47(2015)Supplement 1
• Publication Date: 2015-02
• Subjects: Pathology -- Periodicals; 616.0705
• DOI: 10.1097/01.PAT.0000461417.26971.3e
• Languages: English
• ISSNs: 0031-3025

Abstract

Abstract : We present a case of difficult-to-treat idiopathic cold autoimmune haemolytic anaemia complicated by the sequelae of severe normocytic anaemia and alloantibody formation as a result of transfusion. A 26-year-old previously well female presented with symptomatic anaemia and jaundice. Investigations were consistent with cold autoimmune haemolytic anaemia with intravascular haemolysis and a haemoglobin of 47 g/L. No underlying cause was found. She was treated with prednisolone, rituximab, intravenous immunoglobulin, eculizumab, fludarabine and plasma exchange. She required 24 units of red blood cells until she eventually responded to treatment. During this time, however, her haemoglobin nadir was 27 g/L. She suffered a symptomatic non-ST elevation myocardial infarction and visual blurring due to retinopathy of anaemia. Transfusion in this patient was also not without complication. The patient experienced a mild, but symptomatic haemolytic transfusion reaction due to the development of a red cell alloantibody after a transfusion episode. This case highlights the difficult decision of when to transfuse and the risk of under-transfusion in the management of haemolytic anaemia.