SHM Converge Scientific Abstract ePoster Gallery-Warm Autoimmune Hemolytic Anemia in the Context of Adenovirus

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This case describes a 20-year-old woman with a history of primary membranous nephropathy, hypertension, iron deficiency anemia, preeclampsia, and prior intrauterine fetal demise who presented with weakness, dyspnea, and several days of upper respiratory, gastrointestinal symptoms. She denied bleeding and had only taken losartan.<br /><br />Laboratory evaluation revealed profound normocytic anemia with hemoglobin falling from 3.3 g/dL to 1.9 g/dL, along with leukocytosis, elevated reticulocytes, high LDH, and low haptoglobin, all consistent with hemolysis. Peripheral smear showed spherocytes and red cell regeneration. Direct antiglobulin test was positive for IgG, supporting warm autoimmune hemolytic anemia (w-AIHA). A respiratory viral panel was positive for adenovirus, which was considered the likely trigger. Additional testing for autoimmune, infectious, and other secondary causes was negative, and chest X-ray was unremarkable.<br /><br />During hospitalization, she received 4 units of packed red blood cells, IV methylprednisolone followed by oral prednisone 50 mg daily, and later rituximab infusions. After three days, hemoglobin improved to 7.2 g/dL, near her baseline of 8–10 g/dL.<br /><br />The report emphasizes that w-AIHA is a rare condition caused by antibody-mediated red blood cell destruction and can be primary or secondary to infections, autoimmune disease, malignancy, or medications. Viral triggers such as EBV, CMV, hepatitis C, and HIV are more commonly recognized; adenovirus-associated w-AIHA is particularly uncommon. The case highlights the importance of suspecting w-AIHA in patients with unexplained severe anemia after adenoviral infection, since early diagnosis and steroid treatment can lead to rapid improvement and reduce morbidity and mortality.

Asset Subtitle

Maxwell Hershey

Meta Tag

Author List Kristin Nascimento, Maxwell Hershey, Pinky Jha, Shanna Su, Thomas Matoska

Category Clinical Vignettes

Concept Warm Autoimmune Hemolytic Anemia

Concept Corticosteroid

Concept Hemolysis Marker

Concept Direct Antiglobulin Test

Concept Anemia

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Maxwell Hershey

Track Adult

Keywords

warm autoimmune hemolytic anemia

adenovirus

hemolysis

spherocytes

direct antiglobulin test

corticosteroids

rituximab

severe anemia

packed red blood cell transfusion

respiratory viral infection

Warm Autoimmune Hemolytic Anemia

Corticosteroid

Hemolysis Marker

Direct Antiglobulin Test

Anemia