Autoimmune hemolytic anemia in a preoperative patient: a case report and literature review

Abstract

Background: In patients undergoing elective surgery, it is known that as many as one-third have preoperative anemia. Preoperative anemia is associated with an almost five-fold increase in the likelihood of postoperative mortality. So, it is essential to know the cause of anemia so that the management is appropriate so that surgery can be performed safely and prevent patients from dying on the operating table or postoperatively. This case report aims to describe the pathogenesis of the laboratory findings in a patient with autoimmune hemolytic anemia (AIHA) who was accidentally diagnosed during preoperative screening and the management performed. Case: A 65-year-old man with an enlarged prostate was scheduled for elective surgery. Preoperative examination revealed anemic right and left conjunctiva, decreased erythrocytes, hemoglobin, hematocrit, and increased MCV, MCH, and MCHC, peripheral blood smear dominated by red cell agglutination and positive direct Coomb's test. The patient was given methylprednisolone 62.5 mg intravenously before transfusion and given a transfusion of 2 units of slow drip packed red cells (PRC) under close supervision. There were no transfusion reactions during and after transfusion. There was an increase in Hb after transfusion so that the patient could be operated on. Conclusion: The patient in this case was diagnosed with AIHA based on preoperative laboratory findings. Laboratory results showed evidence of autoimmune hemolytic anemia with decreased erythrocytes, hemoglobin, hematocrits, spherocytes, and agglutination on peripheral blood smear and positive Coomb's test. Rapid identification and treatment of anemia help improve preoperative conditions.