A 32‐year‐old man with no significant medical history presented with complaint of dark‐colored urine, jaundiced skin, and fatigue for the last 4 weeks. He also reported having diarrhea mixed intermittently with blood for last few months. Physical exam was consistent with jaundice and anemia (pallor and icterus), with mild splenomegaly. The initial laboratory workup showed an Hb of 3.8 with a normal platelet and WBC count, serum bilirubin of 3.6 (direct 0.4), and serum LDH of 1032 with normal serum ALT and AST levels. Peripheral smear showed anisopoikilocytosis with increased reticulocytes. Further investigations revealed a positive direct Coombs test, whereas the rest of the relevant investigations were normal, all consistent with a diagnosis of hemolytic anemia. CT abdomen and pelvis showed mild splenomegaly and nonspecific enlarged mesenteric lymph nodes. Colonoscopy showed ulcerative pancolitis confirmed by histological findings of biopsies taken. The patient received PRBC transfusions, was started on steroids and mesalamine, and was discharged on maintenance dose. His symptoms resolved in 4 weeks, and Hb remained stable with no evidence of further hemolysis on his 4‐month follow‐up, and a repeat CT abdomen showed resolution of the lymphadenopathy.
Anemia is a common problem in patients with inflammatory bowel diseases (IBDs), and its etiology is usually multi factorial. It can be produced by chronic blood loss, nutritional deficiencies, and drugs such as salazopyrine; however, it can also be a result of autoimmune hemolysis. The exact underlying pathogenesis of this association remains obscure; however, it has been attributed to the production of cross‐reacting antierythrocytes antibodies. In AIHA associated with IBD, corticosteroids are considered to be firstline therapy and often cause remission of hemolysis along with treatment for IBD. Immunomodulators and splenectomies have been used for patients with refractory AIHA. Colectomy done for fulminant colitis has also been reported to induce remission of AIHA.
Autoimmune hemolytic anemia (AIHA) is a rare complication of IBD and should be kept in mind in a differential diagnosis for anemia in these patients
W. Ahmed, none; Z. Saeed, none.