Transfusion Therapy in Autoimmune Hemolytic Anemia Patient: A Case Report

Abstract

Background: Autoimmune haemolytic anaemia (AIHA) is a relatively uncommon form of haemolytic anaemia characterised by the presence of autoantibodies directed against erythrocyte surface antigens, most frequently of the IgG isotype. A positive direct antiglobulin test (DAT) is a key diagnostic criterion for AIHA. However, when haemolysis involves multiple autoantibodies, the standard DAT (polyspecific, anti-IgG + C3) may fail to detect certain antibodies, potentially delaying appropriate treatment. Case Presentation: We report a patient with severe AIHA mediated by IgG and IgA autoantibodies. A 1-day-old term baby was admitted to the neonatal ICU with chief complaints/diagnoses of biliary atresia with acute biliary encephalopathy, neonatal hepatitis, congenital hydrocele, Rh incompatibility, respiratory failure, seizures and shock. The maternal blood group was AB negative, and the neonatal blood group was AB positive. The neonate presented with a history of abdominal distension, hypoalbuminaemia, sepsis, yellowish discoloration of the skin and moderate thrombocytopenia. Radiological findings, including ultrasonography of the abdomen and pelvis, showed hepatosplenomegaly, cystitis, mild ascites and multiple fluid-filled bowel loops; the neurosonogram showed no significant finding. The direct Coombs test showed IgG positivity and C3d negativity, and the indirect Coombs test was positive. Conclusions: Extended direct antiglobulin test (DAT) evaluation is recommended for all patients presenting with clinical manifestations and laboratory evidence of acute haemolysis. Early identification facilitates prompt diagnosis, minimises the need for unnecessary additional investigations, and enables timely and effective clinical management. Severe autoimmune haemolytic anaemia (AIHA) mediated by multiple autoantibodies necessitates the early initiation of intensive combination therapy, incorporating immunosuppressive agents, intravenous immunoglobulin (IVIG), and plasma exchange.