warfarin and Anemia--Hemolytic--Autoimmune

A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population.

Topics: Anemia, Hemolytic, Autoimmune; Anticoagulants; Child; Cholecystectomy, Laparoscopic; Cholelithiasis; Drug Therapy, Combination; Female; Humans; Hypersplenism; Laparoscopy; Portal Vein; Postoperative Complications; Quinazolines; Splenectomy; Splenic Vein; Venous Thrombosis; Warfarin

Topics: Androgens; Anemia, Hemolytic, Autoimmune; Antigen-Antibody Reactions; Antigens; Autoantibodies; Blood Transfusion; Cold Temperature; Complement System Proteins; Dextrans; Hemagglutination; Hemoglobinuria, Paroxysmal; Hemolysis; Humans; Immunoglobulin G; Immunoglobulin M; Immunosuppression Therapy; Prednisone; Splenectomy; Warfarin

Topics: Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Animals; Anticoagulants; Aortic Valve Insufficiency; Aortic Valve Stenosis; Cardiology; Cattle; Child; Dipyridamole; Dogs; Endocarditis, Bacterial; Extracorporeal Circulation; Female; Heart Valve Prosthesis; History, 15th Century; History, 16th Century; History, 19th Century; History, 20th Century; Humans; Postoperative Complications; Pregnancy; Prosthesis Design; Thromboembolism; Vascular Surgical Procedures; Venoms; Warfarin

PE (pulmonary embolism) is a life-threatening complication rarely seen in the AIHA (autoimmune haemolytic anaemia) patients. Herein we reported a rare and serious AIHA-PE patient characterised by extensive peripheral pulmonary embolism on CTPA.. A 59-year-old woman presented to our ED (emergency department) complaining of acute chest pain and dyspnea. During her presentation in ED she experienced a sudden syncope and soon developed CA (cardiac arrest). Laboratory studies showed a increase of CK-MB,troponin T,myoglobin and D-dimer. Computed tomography pulmonary angiography (CTPA) showed no large central or segment pulmonary emboli but increased RV (right ventricle)size,enlarged main pulmonary artery and invisible peripheral pulmonary artery. She was diagnosed with acute PE and alteplase was delivered intravenously. After thrombolytic therapy she remained hypotension and developed worsening anaemia. Detailed examination for anaemia revealed AIHA. She was discharged in a stable condition after 5 weeks with methylprednisolone and warfarin. Hb, D-dimer and transthoracic echocardiography showed complete recovery at 3-months follow up.. PE attributed to AIHA is characterized by subsegment and distal pulmonary artery embolism which is easily neglected but always life-threatening. This case also highlights the PE as a secondary diagnosis should be evaluated comprehensively in order to identify the underlying pathogenesis.

Topics: Acute Disease; Anemia, Hemolytic, Autoimmune; Anticoagulants; Female; Fibrinolytic Agents; Glucocorticoids; Humans; Methylprednisolone; Middle Aged; Pulmonary Embolism; Shock, Cardiogenic; Syncope; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome; Warfarin

Dabigatran is an orally active direct thrombin inhibitor, initially approved by FDA for the prophylaxis of stroke and systemic embolism in the setting of non-valvular atrial fibrillation (NVAF). Major bleeding is its most common adverse event which is of great concern. However, other types of adverse events such as esophagitis, esophageal ulcer, exanthem and pustular eruptions were reported increasingly in recent years. We present a case of immune hemolytic anemia (IHA) due to dabigatran use in a 72-year-old male with NVAF. This new and rare reported type of adverse event associated with dabigatran suggests that dabigatran may be a new cause of drug-induced immune hemolytic anemia (DIIHI).

Topics: Aged; Anemia, Hemolytic, Autoimmune; Antithrombins; Chronic Disease; Dabigatran; Disease Progression; Drug Substitution; Glucocorticoids; Humans; Immunoglobulins, Intravenous; Male; Treatment Outcome; Warfarin

Bilateral optic neuritis is an extremely uncommon complication of pediatric systemic lupus erythematosus and sporadic cases are reported in the literature. The authors describe an 11-yr-old girl who presented with fever and progressively increasing pallor for 4 months, headache for 7 days, severe anemia and hepatosplenomegaly. Soon after admission, she developed rapid deterioration of vision, worsening to no perception of light with afferent pupillary defect. Fundoscopy showed bilateral optic neuritis. Investigations revealed autoimmune hemolytic anemia and thrombocytopenia. Anti-dsDNA and anti-phospholipid antibodies were positive. Magnetic resonance venography showed multiple thrombi in the cerebral venous sinuses, for which anticoagulant therapy was initiated. She was managed with intravenous methylprednisolone followed by cyclophosphamide pulse therapy for 6 months along with oral prednisolone. Though she went into remission, visual outcome has been dismal, with development of bilateral optic atrophy, and absence of perception of light.

Topics: Anemia, Hemolytic, Autoimmune; Anti-Inflammatory Agents; Anticoagulants; Antiphospholipid Syndrome; Cerebral Veins; Child; Cyclophosphamide; Female; Heparin; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Methylprednisolone; Optic Neuritis; Prednisolone; Thrombocytopenia; Treatment Outcome; Venous Thrombosis; Warfarin

A 67-year-old woman was admitted to the hospital for lethargy, fever, hemolytic anemia, thrombocytopenia, and consciousness disturbance. Direct Coombs test was positive, and anti-cardiolipin beta2-glycoprotein I antibody was detected. She was diagnosed with antiphospholipid syndrome complicated with autoimmune hemolytic anemia (AIHA). She demonstrated variable consciousness disturbance, inability to distinguish right from left, dysgraphia and dyscalculia. Multiple cerebral infarctions, especially dominant cerebral hemisphere infarctions, were observed on magnetic resonance imaging. A ventilation-perfusion scan demonstrated the presence of a ventilation-perfusion mismatch in both lung fields, and multiple veinous embolisms in the right femoral, bilateral the great saphenous and popliteal veins. Therefore, pulmonary embolism and thrombophlebitis were diagnosed. Based on these findings, it was necessary to distinguish this diagnosis from thrombotic thrombocytopenic purpura (TTP). As ADAMTS-13 activity was within the normal range, TTP was denied. Thereafter, the patient was treated with 1 mg/kg of prednisolone for AIHA, 3 mg of warfarin, and 3500 units of low-molecular-weight heparin for thrombosis, and her condition improved.

Topics: ADAM Proteins; ADAMTS13 Protein; Aged; Anemia, Hemolytic, Autoimmune; Anticoagulants; Antiphospholipid Syndrome; Biomarkers; Diagnosis, Differential; Female; Heparin, Low-Molecular-Weight; Humans; Prednisolone; Purpura, Thrombotic Thrombocytopenic; Treatment Outcome; Warfarin

Primary Antiphospholipid Antibody Syndrome (PAPS) and Autoimmune haemolytic anemia (AIHA) is a very rare combination. Antiphospholipid Antibody Syndrome (APS) with underlying SLE, however, has a well documented association with Coomb's positive Auoimmune Haemolytic Anaemia. We describe a young girl with PAPS presenting with deep venous thrombosis, livedo reticularis and features of AIHA. The patient was refractory to treatment for 5 years however, her condition improved dramatically with anticoagulants, corticosteroid therapy and the addition of hydroxychloroquine and azathioprin. We have also discussed hydroxychloroquine therapy in PAPS which is not yet fully established and the probability of this patient developing other autoimmune disorders in future.

Topics: Adolescent; Adrenal Cortex Hormones; Anemia, Hemolytic, Autoimmune; Anticoagulants; Antiphospholipid Syndrome; Antirheumatic Agents; Azathioprine; Comorbidity; Female; Glucocorticoids; Humans; Hydroxychloroquine; Prednisolone; Warfarin

Topics: Adverse Drug Reaction Reporting Systems; Aged; Anemia, Hemolytic, Autoimmune; Anti-Infective Agents; Anticoagulants; Benzodiazepines; Caffeine; Canada; Ceftriaxone; Central Nervous System Stimulants; Child; Drug Interactions; Female; Humans; Ketolides; Middle Aged; Olanzapine; Peripheral Nervous System Diseases; Phytotherapy; Pulmonary Embolism; Rhabdomyolysis; Selective Serotonin Reuptake Inhibitors; Warfarin; Weight Loss

The antiphospholipid syndrome (APS) has been associated with multiple cardiac abnormalities. The present report describes a case of right ventricle thrombus in a 51-year-old woman with a history of autoimmune haemolytic anemia and antiphospholipid antibodies. Transthoracic echocardiography demonstrated the presence of a right ventricle mass, mimicking a myxoma. She underwent open heart removal of the mass and was started on indefinitely anticoagulant therapy. At 2 years follow-up she was free of symptoms.

Topics: Anemia, Hemolytic, Autoimmune; Anticoagulants; Antiphospholipid Syndrome; Diagnosis, Differential; Echocardiography; Female; Heart Diseases; Heart Neoplasms; Humans; Middle Aged; Myxoma; Thrombosis; Warfarin

Topics: Adrenal Cortex Hormones; Adult; Anemia, Hemolytic, Autoimmune; Biopsy, Needle; Diagnosis, Differential; Follow-Up Studies; Giant Cell Arteritis; Glomerulosclerosis, Focal Segmental; Headache; Humans; Intracranial Hypertension; Male; Migraine Disorders; Sleep Apnea Syndromes; Vision Disorders; Warfarin