Abstract
We report a case of Coombs-negative autoimmune hemolytic anemia which was diagnosed by flowcytometric analysis. A 20 year-old man developed anemia and jaundice following flu-like symptoms in August, 1989. He was admitted to the nearby hospital and diagnosed as hemolytic anemia with unknown etiology. Although he started taking prednisolone 30mg/day, severe hemolysis did not improve. More than five units/day of red blood cells were transfused to maintain the Hb level at 5.0g/dl. He was transferred to our hospital on September 12, 1989. On admissin, he revealed severe icteric skin and marked hepatosplenomegaly. The laboratory data were as follows; Hb 5.4g/dl, reticulocytes 101‰, T. Bil. 10.3mg/dl, D. Bil. 4.0mg/dl, LDH 1, 540 IU/l, haptoglobin<10mg/dl. Bone marrow tap showed marked erythroid hyperplasia. These data were compatible with hemolytic anemia. Although the Coombs' test and Polybrene test were all negative, autoimmune hemolytic anemia was suspected. He was treated with steroid-pulse therapy followed by splenectomy, resulting in complete recovery from the hemolysis. Hemosiderosis caused by massive red blood cell transfusion was effectively treated with repeated depletion of the blood in combination with erythropoietin injection. Anti-red blood cell auto-antibodies were retrospectively identified in the serum before steroid-pulse therapy using flowcytometric analysis. Our method to detect anti-red blood cell antibodies using flowcytometry, which is more sensitive than Coombs' test, would be useful for the diagnosis of Coombs-negative autoimmune hemolytic anemia.
