Autoimmune Hemolytic Anemia in Systemic Lupus Erythematosus: Clinical Presentation, Diagnostic Challenges, and Management Strategies

Ramesh T V¹, Gopi Ayyaswamy², Zioni Sangeetha³ and Vinod Kumar P ⁴*

This case determines the importance of early diagnosis and treatment of rare cold agglutinin-induced hemolytic anemia in systemic lupus erythematosus.

Abstract

Background: Cold agglutinin-induced hemolytic anemia is an extremely rare presentation in systemic lupus erythematosus (SLE). This case report discusses a 32-year-old male who presented with severe anemia and was later diagnosed with SLE. The patient exhibited symptoms of fatigue, weight loss, and shortness of breath, and laboratory findings revealed a hemoglobin level of 7 g/dL, positive cold agglutinins, and autoimmune markers consistent with SLE. Methods: A detailed clinical and laboratory investigation was performed, including blood tests, autoimmune profiles, bone marrow aspiration, and positron emission tomography-computed tomography (PET-CT) to assess the extent of systemic involvement. Nerve conduction studies were conducted to evaluate the patient's neurological symptoms. Results: The patient was diagnosed with cold agglutinin-induced hemolytic anemia secondary to SLE. Treatment included corticosteroids, hydroxychloroquine, and antibiotics for an accompanying infection. The patient responded well to treatment, with stabilization of hemoglobin levels and improvement in neurological symptoms. Conclusion: Cold agglutinin-induced hemolytic anemia is a rare initial manifestation of SLE. Early diagnosis and treatment are critical to preventing complications. This case underscores the importance of considering autoimmune hemolytic anemia in patients presenting with unexplained anemia, especially in the context of potential autoimmune diseases like SLE.

Keywords: Autoimmune hemolytic anemia, systemic lupus erythematosus, cold agglutinin disease, corticosteroids.

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