A rare case has been reported of a patient with autoimmune hemolytic anemia (AIHA), thrombocytopenia, and acute kidney injury, as published in Cureus. The researchers noted that the patient ultimately recovered well without the need for corticosteroids.

“The underlying pathophysiologic molecular mechanism in virus-induced cell death is not well known; however, it is thought to be an autoimmune reaction through antigenic mimicry, in which autoantibodies destroy self-antigens,” the authors explained. “After ruling out all other possibilities, we can proclaim virus-induced AIHA as the culprit.”

The case involved a 32-year-old woman with multiple sclerosis who presented to the emergency department with fever for 2 days. Given her positive polymerase chain reaction test for COVID-19, she was hospitalized and within 3 days she became dyspneic, tachycardia, and hypoxic.


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In the intensive care unit, the Coombs profile revealed AIHA, of which cold agglutinin disease is a subtype. Her blood tests showed acute kidney injury, positive immunoglobulin G anti-RBC antibodies, leukocytosis, and thrombocytopenia. She was negative for other infectious diseases.

Read more about the differential diagnosis of cold agglutinin disease

Blood transfusions and hemodialysis were performed and her hemoglobin, platelets, bilirubin, and creatinine gradually improved without the need for steroid treatment. She was discharged home after a few more days.

The authors hope this case will serve as a reminder that in unexplained anemia in patients with COVID-19, AIHA is a possible concurrent condition. The literature has previously reported an association between AIHA, COVID-19, and warm or cold autoantibodies.

In addition, the authors said that this case shows that it is possible to treat these patients by addressing the cause of secondary AIHA without the need to employ corticosteroids. However, further studies are required to determine the association between COVID-19 and AIHA.

Reference

Musa M, Abdalla E, Elhaj M F, et al. A rare case of covid-19 associated with autoimmune hemolytic anemia, thrombocytopenia and acute kidney injury. Cureus. Published online June 16, 2022. doi:10.7759/cureus.26010