Abstract
We report a case of warm-type autoimmune hemolytic anemia (AIHA) associated with systemic lupus erythematosus (SLE), wherein the patient was suspected to have AIHA caused by cold agglutinin disease (CAD) at the
first visit. The patient was eventually diagnosed with warm-type AIHA and her condition improved following
treatment.
The patient was a 66-year-old woman who was admitted to another hospital for angina. After the angina
improved, she was diagnosed with Coombs-positive hemolytic anemia and CAD with a cold agglutinin titer of
256x, in addition to breast cancer and duodenal cancer. Because no hematology specialist was available in the
previous hospital, the patient was transferred to our hospital. The patient was diagnosed with AIHA caused by
low-titer CAD and administered warm blood transfusion, which was ineffective.
Irregular antibodies were detected and irregular antibody-compatible blood was used for transfusion; however,
the hemolysis reaction worsened and the result of a direct anti-globulin test indicated warm-type antibody AIHA.
Thereafter, the patient tested positive for anti-cardiolipin antibodies in addition to anti-nuclear and anti-DNA
antibodies and her lymphocyte count was less than 1,000/μl; therefore, the patient was diagnosed with SLE. Treatment with prednisolone 1 mg/kg improved the various symptoms including anemia. This case presents interesting
findings regarding causative diseases of secondary hemolytic anemia.
