Autoimmune Hemolytic Anemia in the Old Man: A Case Report
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Abstract
Autoimmune hemolytic anemia (AIHA) is considered one of the rare causes of the hemolytic disease. And it can be found as the primary disease or as the complication of various abnormalities including syphilis. Herein we report a case of AIHA in the old man presumably due to latent syphilis. He is a 79-year-old Thai man presenting with gradual fatigue for three weeks without fever and nothing was detected on the physical examination, except for the moderate pallor. His blood tests were found positive for the direct antiglobulin test, VDRL as well as FTA-Abs and HBsAg but normal liver function test. The cerebrospinal fluid showed negative for VDRL. He was diagnosed as having AIHA with the underlying latent syphilis and hepatitis B carrier. After the 3-week treatment with parenteral benzathine penicillin and prednisolone 60 mg. a day was accomplished, his hemoglobin concentration was not increased so azathioprine and danazol were added. Within 10 weeks, Hb level was raised from 5.0 g% to 7.0 g% without blood transfusion. Our case seems to have poor response to any immunosuppressant possibly because of the long term syphilis or hepatitis B virus carrier. Therefore, the investigation of syphilis and hepatitis B virus should not be ignored when the elderly male with AIHA of unobvious causes is encountered.
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