A 50 year old male with previously normal blood work presents to the emergency department with complaints of his skin turning yellow over the past 3 to 4 days. He’s become increasingly dyspneic and tired. His blood work is below with his peripheral blood work showing spherocytes. His DAT is positive.
What is your differential diagnosis and how should he be treated?
Discussion points: treatment of a Warm IgG causing autoimmune hemolytic anemia:
- Transfuse only when necessary (note: every donor blood product will react in the cross match)
- Steroids (often started at >1 mg/kg) with prophylaxis (i.e. PPI, Ca, Vit D)
- Investigate for the underlying cause (i.e. SLE, lymphoproliferative disorder)
- If steroids are ineffective, second line therapy has traditionally been splenectomy
- Alternative therapies for refractory cases: Rituximab (anti-CD 20), immunosuppressants, IVIG