The co-existence of autoimmune hemolytic anemia and iron deficiency anemia: a case report

Abstract

Background: Autoimmune hemolytic anemia (AIHA) is a rare acquired hemolytic disease due to the autoantibody against the antigen upon the own red blood cells whereas the iron deficiency anemia is resulted from the inadequate production of red blood cells due to lack of the iron. Their basic pathogeneses are totally different, so it is hardly to see both entities co-exist. This study is aimed to describe the co-existence of AIHA and IDA simultaneously in a Thai woman. Case Presentation: A 33-year-old Thai woman presented progressive fatigue for a few weeks without blood loss. The physical examination revealed only pallor without jaundice, no hepatosplenomegaly. The blood tests were: Hb 9.0 g%, WBC 4,050/mm³, platelet 238,000/mm³, MCV 90.8 fl, MCH 30.6 pg, reticulocyte 1.72 %, ferritin 8.57 ng/ml and the direct anti-globulin test-weakly positive. The urine hemosiderin was negative. The diagnosis was the co-existence of AIHA and IDA. The treatment was started with oral prednisolone, folic acid and the oral iron tablets. And she responded well to therapy, Hb 11.7 g%, MCV 95.3 fl within 8 weeks. Conclusion: The co-existence of AIHA and IDA is very unusual but they are not mutually exclusive. Its diagnosis is not simple because the microcytosis or hypochromia, the significant clues of IDA, are all masked. Likewise, the jaundice and reticulocytes, the clues of hemolysis with the increased erythropoietic compensation, are not recognized in this co-existence.