Warm autoimmune hemolytic anemia with anti-e specificity: A case report

Abstract

Warm autoimmune hemolytic anemia is a rare condition characterized by warm autoantibody destruction of red blood cells. Antibody specificity cannot be determined in most cases and an apparent autoantibody specificity to a specific antigen is rarely seen. Here we present a case of a 43-year-old female patient presenting with acute small bowel obstruction and requiring an exploratory laparotomy. However, laboratory investigations showed evidence of intravascular hemolysis with normocytic normochromic anemia, reticulocytosis, elevated bilirubin and lactate dehydrogenase levels, and low haptoglobin level. Two units of packed red blood cells were requested. Blood bank investigations including antibody screening, antibody identification panel, direct coombs testing with polyspecific and monospecific anti-human globulin, extended rhesus phenotype, and confirmatory elution testing revealed an IgG autoantibody with anti-e specificity. No compatible units with Rh (e) - positive units were found. However, Rh (e) - negative units’ transfusion was associated with a risk of alloimmunization and a decision of two least incompatible units was taken. So, an anti-e IgG autoantibody was identified which is a rare and challenging clinical condition in terms of diagnosis and transfusion.