Primary Autoimmune Hemolytic Anemia Due To Warm Reactive Autoantibodies: A Rare Case Report

Abstract

Autoimmune hemolytic anemia (AIHA) is an acquired form of hemolytic anemia in which autoantibodies target red blood cell (RBC) membrane antigens, inducing cell rupture (lysis).  It affects both pediatric and adult populations, although its presentation in childhood is relatively rare, with the annual incidence estimated to be approximately 0.8 per 100,000 individuals under 18 years old ^[3]. Here we report  one such a rare case of autoimmune hemolytic anemia due to primary warm reactive autoantibodies in a 3 year old female child. As there was presence of hemolysis in peripheral blood smear &  other investigations also,  Direct coomb’s test was done & it came out to be positive which was suggestive of autoimmune hemolytic anemia, as following lab reports are suggestive of continuous destruction of RBC & after introduction of steroids parameters of  hemolysis came out to be normal suggestive of warm reactive autoantibodies type of AIHA. Clinically also patient improved & her urine colour also became normal after when prednisolone started. Patient also did not have any features of secondary causes of warm autoantibody like Systemic lupus erythematous, immunodeficiency disorders, ulcerative colitis & lymphoproliferative disorders so it was considered primary or idiopathic. W-AIHA tends to have a chronic course and is not expected to subside without treatment. It can be a fatal disease, with a mortality rate of up to 4% in children, either because of the acuity of the presentation or because of being refractory to treatment and requiring multiple lines of therapy with frequently associated toxicity ^[14]. Fortunately our patient responded to steroid therapy.