2022 Volume 59 Issue 3 Pages 314-318
A five-year-old girl presented with pallor that had persisted for three weeks. A blood test showed low titers of both hemoglobin and haptoglobin, and high titers of reticulocytes, total bilirubin, and LDH with a positive result of the direct Coombs’ test; accordingly, autoimmune hemolytic anemia (AIHA) was diagnosed. A palpable mass was detected in the lower abdomen. CT revealed a presacral cystic lesion. Her anemia improved upon prednisolone (PSL) administration, and we performed tumorectomy without transfusion to establish a definitive diagnosis and eliminate the cause of AIHA. Pathological findings identified mature cystic teratoma, the cystic fluid of which showed positive results of the indirect Coombs’ test. Postoperatively, the Coombs’ test result was negative and the PSL dose was gradually decreased. She was then in remission without relapse. These suggest that pediatric patients with AIHA might also have teratoma in areas other than the ovaries and that transfusion during surgery can be avoided if steroids are administered prior to tumor resection.
