SHM Converge Scientific Abstract ePoster Gallery-Hot 'N Cold: A Rare Case of Mixed-Type Autoimmune Hemolytic Anemia

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This case report describes a 76-year-old woman with fatigue, headaches, and chronic watery diarrhea who was found to have severe hemolytic anemia with thrombocytopenia and macrocytosis. Initial labs showed low hemoglobin, elevated LDH, very low haptoglobin, and a high reticulocyte count, supporting active hemolysis. A peripheral smear showed no schistocytes, and CT imaging ruled out acute bleeding. Further workup revealed positive ANA and anti-SSA antibodies, but testing for infection and other autoimmune causes was largely negative. Although imaging raised concern for malignancy, bone marrow biopsy, lung biopsy, PET scan, and brain MRI did not show cancer or a lymphoproliferative disorder.<br /><br />The patient was Coombs positive for both warm and cold antibodies, leading to the diagnosis of mixed-type autoimmune hemolytic anemia (AIHA), a rare subtype that accounts for about 10% of AIHA cases. Mixed AIHA may be associated with lymphoma, lupus, infection, or be idiopathic. Diagnostic clues include anemia, elevated LDH, decreased haptoglobin, reticulocytosis, increased bilirubin, and a positive direct antiglobulin test.<br /><br />During hospitalization, she required transfusions of warm packed red blood cells, platelets, and fresh frozen plasma. She was treated with intravenous methylprednisolone, then transitioned to an oral prednisone taper, and later completed four weeks of rituximab. The report emphasizes that steroid response in mixed AIHA is variable, while rituximab may be effective.<br /><br />Overall, this case highlights the diagnostic complexity of mixed AIHA and the importance of considering it in patients with unexplained hemolytic anemia. Early recognition is essential for timely treatment and improved outcomes.

Asset Subtitle

Inaas Shirazi

Meta Tag

Author List Deepinder Osahan, Inaas Shirazi, Jiya Mulayamkuzhiyil, Jonathan London, Sahar Khan, Sanjeev Jain

Category Clinical Vignettes

Concept Mixed Autoimmune Hemolytic Anemia

Concept Autoimmune Hemolytic Anemia

Concept Hemolysis

Concept Direct Antiglobulin Test

Concept Corticosteroids

Distinguished Non-Finalist

Presenter Organization Long Island Community Hospital

Presenting Author Inaas Shirazi

Track Adult

Keywords

mixed autoimmune hemolytic anemia

AIHA

hemolytic anemia

Coombs positive

warm and cold antibodies

thrombocytopenia

rituximab

prednisone

methylprednisolone

reticulocytosis

Mixed Autoimmune Hemolytic Anemia

Autoimmune Hemolytic Anemia

Hemolysis

Direct Antiglobulin Test

Corticosteroids