Melek Kechida* and Noel Lorenzo Villalba

Pernicious anemia is an autoimmune disease rarely occurring with autoimmune hemolytic anemia. In this article we report the case of a 57 year old woman presented to the internal medicine department with a history of increasing weakness and shortness of breath during 2 weeks. Clinical examination revealed marked pallor, moderate jaundice, fever, tachycardia and enlarged spleen without other lymph nodes. A full blood count showed pancytopenia with a regenerative macrocytic anemia at 3.3 g/ dl. White blood cells were at 3500 elt/ mm3 and platelets at 27000. Blood biochemistry showed elevated indirect bilirubin, liver cytolysis and high LDH levels. Schizocytes were at 2%. Direct antiglobulin test at 37°C was strongly positive for IgG and C3D. A bone marrow differential count confirmed the diagnosis of megaloblastic anemia due to vitamin B12 deficiency. Intrinsic factors antibodies and parietal cell antibodies were positives. Fever was secondary to urinary infection treated with antibiotics. A diagnosis of warm antibody type auto immune hemolytic anemia complicating pernicious anemia was made. Corticosteroids associated with vitamin B12 were administered with good outcome.

Cite this Article: Kechida M, Villalba NL. Multiple Mechanisms Occurring Simultaneously Leading to Severe Anemia. American J Res Rheumatol. 2017;1(1): 001-002.

Published: 16 December 2017