Revista de Ciencias Médicas de Pinar del Río (Jun 2017)
Autoimmune hemolytic anemia with negative Coombs test
Abstract
Introduction: autoimmune hemolytic anemia is a type of low-grade acquired hemolytic anemia, produced by antibodies against the patient's own erythrocytes leading to their destruction. Case report: a 12 year-old female patient arrived in the emergency room for shortness of breath and headache. She noticed colored urine and stools from a week of evolution and 2 days earlier began with severe headache, fever, vomiting, loss of appetite and marked weakness. She was hospitalized due to suspected leptospirosis. Hemoglobin: 50 gl, Hto: 015 L / L. Reticulocyte count: 16x10 -3 / L. Total bilirubin: 63 mmol / L, direct bilirubin: 12 mmol / L, Indirect bilirubin: 51 mmol / L, Coombs direct: negative. Leptospira rapid test: Negative. On the third day: Hemoglobin: 50 gl, Hematocrit: 015 L / l. Erythrocytes: 100 mm / h. Reticulocyte count: 5x10-3. She was transfused, hydrated and underwent antibiotic treatment, employs intacglobin and prednisone. On the seventh day: Coombs direct: IgG positive with activity at 37 ° C. Treatment continued: at day 21 Hemoglobin: 85 g / L, Hematocrit: 0.25 L / L, Reticulocyte count: 200 x 10-3. Conclusion: sepsis and autoimmune hemolytic anemia was the definitive diagnosis. The caso of this patient constitutes an interesting case to show in the beginning negative test of Coombs that later when imposing the appropriate treatment and diminishing the lysis of erythroid cells, was positive and allowed the diagnosis of certainty which contributed to the good final evolution of the patient.
