Abstract
We presented a two-month-old girl with severe autoimmune hemolytic anemia (AIHA) who was successfully treated by extracorporeal membrane oxygenation (ECMO). The patient visited her previous physician for poor complexion; with anemia subsequently noted. Due to a positive direct Coombs test which rendered cross-matching test unsuitable, the patient was transferred to our hospital without any blood transfusion. At admission, she was in a state of shock with respiratory distress, requiring emergency attention that included tracheal intubation, type O Rh+ erythrocyte transfusion and rapid fluid resuscitation. Initial blood test showed hemoglobin level of 1.6 g/dl, at pH 6.76, with -27.7 mmol/l of base excess and 22 mmol/l of lactic acid. Echocardiography revealed significant impairment of left ventricular contraction. Catecholamine treatment did not recover the cardiogenic shock, and ECMO was eventually started five hours after admission. The ECMO treatment was effective for the recovery from the cardiogenic shock. The patient was withdrawn from ECMO on day 5, and was discharged without any neurological deficit. This is the first report of ECMO being used for infant cardiogenic shock arising from AIHA. Going forward, we propose ECMO as an important consideration for the management of severe AIHA.
