Cold antibody autoimmune hemolytic anemia following varicella infection

Introduction: Autoimmune hemolytic anemia (AIHA) is a rare complication of chicken pox. In adults, such AIHA is due to warm antibodies. We report a case of cold antibody AIHA following chicken pox in a young female. Case Report: A 24-year-old female presented with clinical and laboratory features consistent with hemolytic anemia 5 days after the onset of chicken pox. Her hemoglobin levels dropped rapidly during the course of admission from 7.9 to 3.8 g/dL with evidence of ongoing haemolysis in the form of rising total and indirect bilirubin. Peripheral smear revealed red cell agglutinates and erythrophagocytosis. Direct Coomb's test (DCT) was positive for C3d suggesting a cold antibody AIHA. Since test for Donath Landsteiner antibody was negative, and all other tests for common causes of hemolytic anemia were noncontributory, it was presumed to be due to chicken pox. The fulminant course necessitated a short course of oral steroids to which she responded with rise in hemoglobin and no further hemolysis. Two weeks later, her peripheral smear was normal and DCT negative. Conclusion: In patients presenting with acute onset anemia following chicken pox, possibility of cold antibody AIHA must be considered and appropriate testing pursued. Despite lack of empiric evidence, short course of steroids may be beneficial if drop in hemoglobin is rapid with evidence of fulminant hemolysis, showing no abatement after first week.

How autoantibodies interfere with the identification of alloantibodies / 中国输血杂志

【Objective】 To explore a method to accurately identify the specificity of alloantibodies or autoantibodies in autoimmune hemolytic anemia (AIHA)patients with both warm and cold antibodies, so as to provide guidance for the selection of blood components. 【Methods】 Blood samples of AIHA patients with both warm and cold antibodies were screened by the direct antiglobulin testing (DAT). The plasma of patients were treated with dilution or adsorption method and the erythrocyte was dispersed for specificity identification of alloantibodies or autoantibodies.According to the results of antibody identification, appropriate phenotype of red blood cells(RBCs) were transfused to patients, and the incidence of adverse reactions and efficacy of transfusion were observed. 【Results】 Alloantibodies or specific autoantibodies were detected in serum or elution in 14 of the 16 patients. 10 patients underwent blood transfusion during hospitalization, and all of them received RBCs with the same or compatible ABO/Rh (D) type as the patients and without any reaction to the alloantibodies and specific warm autoantibodies. No hemolytic reaction occurred, and anemia symptoms were improved after blood transfusion. 【Conclusion】 The selection of appropriate methods could eliminate the influence of autoantibodies on the identification of alloantibodies in AIHA patients with both warm and cold antibodies. Therefore, the selection of blood from compatible donors for transfusion could effectively avoid the occurrence of hemolytic reaction.