Auto-Immune Haemolytic Anaemia in Ulcerative Colitis: Report of Three Cases

Dr. Fernando Hernández, Hospital General Universitario, Servicio de Hematologia, Avenida Tres Cruces s/n, E-46014 Valencia (Spain) Auto-immune haemolytic anaemia (AIHA) is a rare but severe complication of ulcerative colitis (UC) occurring in fewer than 1% of cases [1-4]. We present 3 cases of AIHA associated with UC. Case 1 A 31-year-old man with a 10-year history of UC was admitted to the hospital in December 1992 for total proctocolectomy because of persistent colitis. A subtotal colectomy was performed 9 years before. On admission, his haemoglobin (Hb) level was 10.7 g/dl; leucocyte and platelet counts were normal. Reticulocyte count was 304 × 109/1, bilirubin 1.6 mg/dl, haptoglobin 0.23 g/l (normal value 1-2) and LDH 525 U/l (normal value 150-450). The direct antiglobulin test (DAT) was positive (anti-IgG), indirect antiglobulin test and eluate were also positive. After 7 days prednisone treatment (1 mg/kg/day) his Hb rose to 13.8 g/dl. The patient underwent total proctocolectomy in January 1993. Steroids were reduced gradually and stopped in February 1993. Despite not having received treatment for 4 months, he felt perfectly well and his Hb level was 15 g/dl. He still had a weakly positive DAT. Case 2 A 39-year-old woman was diagnosed as having UC in 1986. In October 1989, she was admitted to the hospital with acute haemolytic anaemia. Her Hb level was 6.7 g/dl, reticulocyte count was 196 × 109/1, bilirubin 3.2 mg/l, haptoglobin 0 g/l and DAT was positive (anti-IgG). Indirect antiglobulin test and eluate were positive. The patient was started on 2 mg/kg/day of prednisone, and her Hb rose to 12.7 g/dl over 3 months. Steroids were discontinued but DAT remained positive although weaker than previously.