A Case of Severe Autoimmune Hemolytic Anemia

Introduction: We present the case of a 5 months old baby with severe hemolytic anemia.

Case presentation: The infant was admitted through transfer from another hospital with the diagnosis of severe anemia (Hemoglobin (Hb) = 3.6 g/dl) - apparently with sudden onset, no infections or treatments administered within the last 7 days.

The clinical examination revealed a baby in poor clinical condition with intense pale skin, scleral icterus, tachycardia (150 -170 b/min), systolic murmur of 2/6 in the V-th parasternal left space, hepatosplenomegaly.

The blood analysis indicate severe autoimmune hemolytic anemia (Hb = 3.6 g/dl, with high reticulocyte count, hyperbilirubinemia, hypersideremia , positive Coombs test).

The blood transfusion was postponed (due to the presence of several classes of autoantibodies - IgG 3+; IgM 2+; C3c+/-; C3d3+) and treatment with corticoids was started (first intravenously with Methylprednisolone 30 mg/day, slowly tapered and then orally with Prednisone).

Under the treatment, the evolution was favourable - from both clinic (good general condition, normal skin colour, no jaundice or hepatosplenomegaly) and biologic point of view (with progressive increase of the hemoglobin until the normal value for the age, negative direct Coombs test and normal values of sideremia and bilirubinemia).

Conclusion: It is essential that patients with severe anemia be admitted in a department were they can be completely investigated in order to get the appropriate treatment.