Warm antibody autoimmune hemolytic anemia in pregnancy: A case report

Abstract

Introduction. Warm autoimmune hemolytic anemia is the presence of warm autoantibodies against red blood cell with or without complement activation. The presence of warm autoantibodies on the red blood cells is detected by direct antiglobulin test with polyspecific and immunoglobulin G reagents. Antibodies removed from the red blood cells tested by indirect antiglobulin test show panagglutination with a panel of red blood cells. Case Report. We report a rare case of idiopathic warm autoimmune hemolytic anemia in a 26-year-old woman in the early pregnancy. Warm autoimmune hemolytic anemia was mild, so during monitoring the risk to the fetus was assessed as low. The fetal status was assessed every four weeks. The noninvasive Doppler examination of the fetal middle cerebral artery revealed no fetal anemia. The last control before childbirth was done in the 38 week of pregnancy and the fetal direct antiglobulin test was 4+ and indirect antiglobulin test was 2+. The newborn presented with warm autoantibody immunoglobulin G, and positive direct antiglobulin test (3+). The infant was breastfed for nine months after birth. The direct antiglobulin tests were positive (3+) in both mother and child over the following 12 months. Conclusion. In case of warm autoimmune hemolytic anemia, the main purpose is to stop hemolysis and correct anemia in pregnant women, but it is also necessary to monitor the fetal condition in order to detect fetal hemolytic anemia as early as possible.