Acute Tubular Necrosis Associated with Autoimmune Hemolytic Anemia due to Acute Gastroenteritis

Abstract

Abstract Autoimmune hemolytic anemia (AIHA) is a rare disease with a rate of 1-3 in 100,000 in adults. AIHA are defined as primary (idiopathic) or secondary depending on the presence or absence of accompanying disease. Secondary causes include drugs, immunodeficiencies, infections, other autoimmune diseases, or malignancies. Here, we report an 42-year-old female presented to us with diarrhea, nausea-vomiting, fever, chills and jaundice for two days. Hematological investigations revealed hemolytic anemia. Direct Coombs test was positive. The patient was diagnosed acute tubuler necrosis with autoimmune hemolytic anemia. Methylprednisolone 40 mg/day was started considering autoimmune hemolytic anemia. She was on hemodialysis at regular intervals. After 4 weeks, the patient was symptomatically improved with remission of acute tubuler necrosis and hemolytic anemia. In our case, the association of AIHA due to acute gastroenteritis and acute tubular insufficiency was considered suitable for the presentation because of its rare occurrence.

Keywords

• Acute Tubular Necrosis
• Autoimmune Hemolytic Anemia
• Acute Gastroenteritis

References

1. Kalfa TA. Warm antibody autoimmune hemolytic anemia. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):690-697.
2. Jäger U., Barcellini W., Broome C.M., Gertz M.A., Hill A., Hil Q.A., Jilma B., Kuter D.J., Michel M., Montillo M., et al. Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendations from the First International Consensus Meeting. Blood Rev. 2020;41:100648.
3. Berentsen S. How I manage patients with cold agglutinin disease. Br. J. Haematol. 2018;181:320–330.
4. Bell CA, Zwicker H, Sacks HJ. Autoimmune hemolytic anemia: Routine serologic evaluation in a general hospital population. Am J Clin Pathol. 1973;60:903–911.
5. Sokol RJ, Hewitt S, Stamps BK. Autoimmune hemolysis: An 18-year study of 865 cases referred to a regional transfusion centre. Br Med J. 1981;282:2023–2027.
6. Giannotta JA, Fattizzo B, Cavallaro F, Barcellini W. Infectious Complications in Autoimmune Hemolytic Anemia. J Clin Med. 2021;10(1):164. Published 2021 Jan 5.
7. Rose N.R. Predictors of autoimmune disease: Autoantibodies and beyond. Autoimmunity. 2008;41:419–428.
8. Barcellini W. New Insights in the Pathogenesis of Autoimmune Hemolytic Anemia. Transfus. Med. Hemother. 2015;42:287–293.

9. Durrance RJ, Das Gracas F, Sivamurthy S, Singh BB. Legionella-Induced Autoimmune Hemolytic Anemia: A Delayed and Unexpected Complication. J Hematol. 2019 Mar;8(1):44-45.
10. Mak WW, Adrian MM, Ahlam K. Brucellosis-induced autoimmune haemolytic anaemia (AIHA). Med J Malaysia. 2019 Oct;74(5):443- 344.
11. Wilkinson L.S., Petz L.D., Garratty G. Reappraisal of the role of anti-i in haemolytic anaemia in infectious mononucleosis. Br. J. Haematol. 1973;25:715–722.
12. Atta M., Brannigan E.T., Bain B.J. Cold autoimmune hemolytic anemia secondary to atypical pneumonia. Am. J. Hematol. 2017;92:109.
13. Maslov D.V., Simenson V., Jain S., Badari A. COVID-19 and Cold Agglutinin Hemolytic Anemia. TH Open. 2020;4:e175–e177.