An autoimmune hemolytic anemia and an ovarian cyst: a case report

Abstract

Autoimmune hemolytic anemia (AIHA) is a rare acquired disease caused by the antibody specifically against some antigens upon the surface of the own red blood cells (RBC). It may spontaneously occur or it can be rarely found as a paraneoplastic syndrome in the patients with various solid tumors. Herein we reported a case of AIHA diagnosed in a patient with an ovarian cyst. She was a 72-year-old Thai patient who had low-graded fever for a week. The physical examination revealed pallor and a large cystic mass occupying the entire left lower abdomen without tenderness. The blood tests were: Hb 8.4 g%, WBC 13,470/mm³, platelet 455,000/mm³, MCV 80.6 fl, reticulocyte 2.6 %, direct anti-globulin test 1+, indirect anti-globulin test 2+, ANA-negative, CA-125 50.4 U/ml, Hb analysis-normal, osmotic fragility-positive. The ultrasonography of the whole abdomen showed a 7.2x11.6x15.6 cm cyst at the left adnexa with internal fluid/fluid level and one septation. She was diagnosed as having AIHA and a large ovarian cyst. And she was treated with corticosteroid and responded well. Hb was 9.5 g% whereas the direct anti-globulin test became weakly positive within one month. AIHA in our patient could be much improved with just only the corticosteroid therapy although the resection of the cystic ovarian mass was not allowed. This outcome was different from nearly all other cases of AIHA associated with tumors. So, AIHA in our case looked likely to be the co-incidence more than the paraneoplastic syndrome of the ovarian tumor. Therefore in a case of AIHA happening in patients with various tumors and the operation could not be accessed due to any reason, the corticosteroid therapy should be considered one of the initialtherapies of choice.