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Abstract

This report and literature review describes a case of a Coombs test-positive warm antibody autoimmune hemolytic anemia (AIHA) in a patient following routine spinal surgery without complications. This is the first reported case of symptomatic direct Coombs test-positive warm antibody AIHA developing in a neurosurgical patient.

The patient is a 73-year-old female with left radicular leg pain who developed warm antibody AIHA following standard uncomplicated spinal surgery. A positive direct Coombs test confirmed the diagnosis in combination with characteristic laboratory values. The patient did not have any significant predisposing risk factors. On postoperative day (POD) 23, she presented with fatigue and characteristic laboratory values of decreased hemoglobin, elevated bilirubin, lactate dehydrogenase, and decreased haptoglobin. Hematology initiated and monitored appropriate treatment and proposed that the working hematologic diagnosis is stress-induced AIHA secondary to recent spinal surgery. The patient recovered well from a neurosurgical perspective and reported no neurosurgical complaints during the last follow-up.

A female presenting with left radicular leg pain developed symptomatic anemia following uncomplicated spinal surgery. A positive direct Coombs test in combination with characteristic laboratory values confirmed the diagnosis of warm antibody AIHA.

Introduction

Autoimmune hemolytic anemia (AIHA) is a rare autoimmune disease that leads to hemolysis from the formation of autoantibodies and is classified as a type II hypersensitivity reaction. AIHA has an incidence of 0.8 to 3 people per 100,000 and a mortality rate of 11% [1]. AIHA can be classified as primary AIHA, which has an idiopathic etiology, or secondary AIHA. Secondary AIHA can present with other autoimmune diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and others. Many infections, such as babesiosis and infectious mononucleosis due to cytomegalovirus (CMV), have also been associated with AIHA. AIHA has also been linked to many hematological malignancies, most notably chronic lymphocytic leukemia (CLL) [1-4]. A variety of medications have also been reported to cause AIHA, including penicillin and...(More)

For more info please read, Autoimmune Hemolytic Anemia Following Uncomplicated Spinal Surgery: A Report and Brief Review, by Cureus