Pulmonary tuberculosis associated with autoimmune hemolytic anemia

Pulmonary tuberculosis could be associated with certain types of anemia, such as normocytic normochromic anemia and microcytic hypochromic anemia; however, it is rarely associated with autoimmune hemolytic anemia

We report a case of a child with pulmonary tuberculosis associated with autoimmune hemolytic anemia and iron deficiency anemia which was resolved with anti-tuberculosis medications, isoniazid, pyrazinamide, rifampicin and ethambutol

Prevalence and aetiology of anaemia in lymphoid malignancies.

Background. We prospectively studied the prevalence, type and causes of anaemia in newly diagnosed patients with lymphoid malignancies. Methods. Between January 2007 and June 2008, a total of 316 newly diagnosed, consecutive patients (aged 15 years or above) of Hodgkin lymphoma, non-Hodgkin lymphoma and chronic lymphocytic leukaemia with anaemia (haemoglobin <11 g/dl), were analysed to determine the prevalence and a subgroup of 46 patients was analysed for the cause of anaemia. Results. Hodgkin lymphoma, non-Hodgkin lymphoma and chronic lymphocytic leukaemia were the diagnoses in 81 (25.8%), 203 (64.7%) and 30 (9.6%) patients, respectively. Anaemia was present in 134 patients (42.4%). Anaemia of chronic disease was present in 33/46 (71.7%) and iron deficiency in 18/46 (39.1%) patients. Vitamin B12 and/or folate deficiency was detected in 10/46 (21.7%) patients (B12 deficiency alone in 7, folate deficiency alone in 1 and combined B12 and folate deficiency in 2). Autoimmune haemolytic anaemia was detected in 5/46 (10.9%) although direct Coombs test was positive in 17/46 (37%) patients. Among patients with Hodgkin lymphoma and non-Hodgkin lymphoma, anaemia due to bone marrow involvement was present in 16/40 (40%). In most patients with bone marrow involvement, anaemia was due to other causes. In only 3 patients, anaemia was attributable to bone marrow involvement alone. Anaemia was multifactorial in 18/46 (39.1%) patients. Nutritional deficiency alone or in combination was present in 22/46 (47.8%) patients. Conclusion. Anaemia is common in lymphoid malignancies at initial presentation. Besides managing anaemia of chronic disease and bone marrow involvement, nutritional and autoimmune causes should be ruled out.

Infección por Mycoplasma neumoniae: microangeitis cerebral, síndrome de Bickerstaff y anemia hemolítica autoinmune / Mycoplasma pneumoniae infection: cerebral microangeitis, bickerstaff syndrome and autoimmune hemolytic anemia

Mycoplasma pneumoniae produce 10 to 20 percent of atypical pneumonia, and secondarily affects by autoimmune mechanisms the central and peripheral nervous system. This presentation prospects to understand others pathologies than pneumonia, originated by mycoplasma pneumonia, like hemorrhagic cerebral microvasculitis, Bickerstaff syndrome and autoimmune hemolytic anemia expressed by an adolescent. They were an immunomimetic manifestation of this bacteria, same days after pulmonary box. The microvasculitis shows blood in the CSF, retinal hemorrhages and special MR imaging s. Protuberancia! syndrome was identified by a multidirectional nystagmus, facial diplegia, involvement of the sixth cranial nerve and quadriplegia with pyramidal signs. The autoimmune hemolytic anemia was the last complication. Generally all these syndromes have been isolated described in relation to this bacterial infection. In this case they occurred simultaneously. The cerebral vasculitis took a special way, apparently not described before with these characteristics. Our conclusions are that mycoplasma pneumoniae can affect simultaneously different parenchyma expressing immunomimetic responses.

El Mycoplasma neumoniae es una bacteria productora del 10 al 20 por ciento de las neumonías atípicas, que secundariamente y por patomecanismos inmunomiméticos afecta al sistema nervioso central y periférico. Con esta presentación se busca dar significado a las variadas alteraciones que originó una neumonía por mycoplasma en un adolescente, que además presentó una micro vasculitis cerebral hemorrágica, un síndrome de Bickerstaffy una anemia hemolítica autoimune, como expresión de una respuesta inmunomimética desencadenada por la bacteria, días después de cuadro pulmonar. La microvasculitis produjo presencia de sangre en el LCR, hemorragias retinianas y una RM con imágenes características. El síndrome rombencefálico se identificó por un nistagmus multidireccional, diplejia facial, compromiso del sexto par y cuadriparesia con signos piramidales, que secuencial mente se complicaron con una anemia hemolítica autoimune. Todos estos síndromes han sido descritos aisladamente en relación a esta infección bacteriana, sin embargo, en este caso se produjeron simultáneamente y la vasculitis cerebral tomó un modo especial, al parecer no descrito antes con esas características. Se concluye que el mycoplasma neumoniae puede afectar con respuestas inmunomiméticas diversos parénquimas simultáneamente.

Pulmonary sarcoidosis and autoimmune hemolytic anemia: possible common immune pathogenesis

A 49-year-old female presented with autoimmune hemolytic anemia and positive warm antibodies. She was diagnosed with chronic pulmonary sarcoidosis. The patient was given prednisolone after which she had complete remission of autoimmune hemolytic anemia and stabilization of her pulmonary status. A review will follow on association of sarcoidosis with autoimmune disease and its possible role in the development of such phenomenon

Evaluation of fetomaternal hemorrhage after post - abortion therapeutic curettage

Hemolytic diseases in fetus and newborn were known for years; the principle of these pathologies is defined Basically entrance of fetal blood cells to maternal circulation results in these ranges of diseases. Risk factor determination, early diagnosis of F.M H and adequate dosage of Anti - D Ig administration will be attempted to prevent subsequent adverse outcome on fetus and newborn. The quantification of fetal cells in the maternal circulation post - curettage miscarriage remains an important goal to prevent active immunization in mother. In this cross sectional study, during six months, from April 2004, one hundred patients post - abortion therapeutic curettage enrolled, in Ghaem Hospital, Mashhad University. Maternal age, gestational age, maternal blood group and Rh, gravidity, severity of maternal hemorrhage, HcT, BP and duration of vaginal bleeding were recorded. The KB test was done in all patients amount of FIMIH and Rh IgG dosage in positive KB patients were calculated. Data were analyzed with SPSS [Ver. 10] software. The KB test was positive in 35% of the patient. Gestational age, maternal H.ct, pain and severity of hemorrhage had significant relation to K.B test positive. F.M.H was 0.1-5 cc in 17 patients and in 18 it was less. Lower gestational age in abortion time decreases FMH risk the usual Rh - IgG dosage [50 micro gr] sounded to be adequate for Rh Immunization after post - abortion therapeutic curettage

Síndrome aglutininas frías / Cold agglutinin syndrome

El síndrome de aglutininas frías es una forma de anemia hemolítica autoinmune poco común. Fue descrito por primera vez hace más de un siglo. En ésta entidad, la lisis de los glóbulos rojos es la medida para la activación del complemento, pero mayormente interviene la fagocitosis por el sistema retículo endotelial. Esta hemólisis ocurre a temperaturas inferiores a 37ºC. La presentación puede ser idiopática o secundaria y su tratamiento está relacionado con la causa de fondo. A continuación se presenta el caso de una paciente de 80 años con anemia hemolítica y síntomas respiratorios asociados al uso ambulatorio de antibióticos, cuyos resultados de laboratorio mostraron títulos altos de aglutininas frías. Descriptores: aglutininas frías, anemia hemolítica autoinmune, anticuerpos fríos, síndrome aglutininas frías.

Autoimmune hemolytic anemia associated with benign ovarian cyst: a case report and review of literature.

A 28-years-old female presented with severe autoimmune hemolytic anemia (AIHA), warm antibody mediated, and right side tubo-ovarian (TO) mass. There was sub-optimal response to immunosuppressive therapy (IST). Eight months later she underwent ovarian cystectomy which resulted in complete remission of AIHA without the need for IST. Pathological examination of the TO mass revealed benign ovarian cyst. Our case highlights the need to search for ovarian cyst/mass in females presenting with AIHA. Since immunosuppressive therapy is usually ineffectual in AIHA associated with ovarian cyst, it may be appropriate to contemplate surgery before embarking on IST in such cases.

Anemia hemolítica autoinmune en paciente infectado por virus de inmunodeficiencia humana y enfermedad de Castleman / Autoimmnune hemolytic anemia in AIDS-HIV patient

We present a case of a 41 years old C3 phase AIDS patient on antiretroviral therapy for 5 years, who developed a severe hemolytic anemia refractory to usual treatment, which progressed to death. Anemia in AIDS patients is a common finding (60-80%); however hemolytic anemia is unusual and when it is present, it is generally mild; severe anemia is associated with bad prognosis. The etiology of hemolytic anemia in HIV patients is due to multiple causes, the one mediated by autoantibodies against the red cell, usually IgG, being most common. The antibodies most frequently detected are against U or i antigen. Drug-related hemolysis, in glucose 6-phosphate dehydrogenase (G-6PD)-deficient patients, may also occur. A third mechanism of hemolysis is related to microangiopathy secondary to bacterial sepsis or hemolytic uremic syndrome (HUS). Some reports associate haemolytic anemia and Castleman´s disease, a lymphoproliferative disease with localized widespread adenopathy, fever, autoimmune manifestations and recurring infections.

Se presenta un paciente con SIDA etapa C3, 41 años de edad, en tratamiento antiretroviral durante 5 años, que cursó con linfoadenopatías generalizadas y anemia hemolítica severa refractaria a tratamiento, con progresión hacia la muerte. La anemia en pacientes con SIDA es un hallazgo común (60-80%). Sin embargo, la anemia hemolítica es poco frecuente y generalmente de escasa magnitud, pero si es severa se relaciona con mal pronóstico. La etiología de la anemia hemolítica en pacientes VIH es múltiple siendo más común la mediada por autoanticuerpos contra antígenos del eritrocito, en su mayoría IgG. Los más frecuentes son dirigidos contra antígeno U e i. Otra causa frecuente es la inducida por fármacos, en pacientes con déficit de G-6PD. Un tercer mecanismo de hemólisis es el producido por microangiopatía secundaria a sepsis bacteriana o síndrome hemolítico urémico. Algunas publicaciones asocian anemia hemolítica y enfermedad de Castleman, desorden linfoproliferativo que se puede presentar clínicamente como una masa localizada o una alteración sistémica con linfoadenopatías, fiebre, manifestaciones autoinmunes e infecciones recurrentes.

Spectrum of immune haemolysis in children

Immune haemolysis is frequently encountered in paediatric age group. A correct diagnosis is important for management and prevention and must be performed on samples obtained before initiation of any therapy. This study was carried out on newly diagnosed patients to correctly assess the magnitude of problem. We investigated all patients of suspected immune haemolysis referred to Armed Forces Institute of Pathology [AFIP] from all military hospitals and most of the civil hospitals in Rawalpindi. Relevant aetiological investigations were carried out in each case. Nine patients of less than 15 years age were seen during one year period of study, 3 patients with alloimmune antibody and 6 with autoantibody. These do not include cases of haemolytic disease of newborn [HDN]. In 3 patients of alloimmune haemolysis antibody developed after multiple transfusions. Anti-c antibody was detected in 02 patients and anti Lea in one patient. There were 6 patients with autoimmune haemolysis. Two were of cold antibody type with anti-I specificity, two of warm antibody type with pan-reactive antibody and 2 were with mixed cold and warm antibodies. Warm component was anti-K in one patient and pan-reactive antibody in other patient. Anti-I was detected as cold component in both patients

Cold haemagglutinin disease in systemic lupus erythematosus

A 34-year-old lady presenting with features of cold agglutinin disease during the course of systemic lupus erythematosus is described. Cold antibody titer was very high (1 in 4096) with specificity for 'I' antigen. Even though she had poor prognostic factors like high titer of cold antibodies with low thermal amplitude, she responded well to prednisolone.