An autoimmune double attack

摘要

In February, 2011, a 66-year-old woman was admitted to our hospital with fatigue, jaundice, and macroscopic haematuria. In the week before admission she had experienced recurrent episodes of nausea, vomiting, and haematuria with no fever. Medical history included successful breast cancer treatment at the age of 59 years, and excision of a basal-cell carcinoma of the forehead 12 months earlier. She was not taking regular medication but had been given cotrimoxazole for cystitis 24 h earlier. Blood tests showed anaemia (haemoglobin 56 g/L) and leukocytosis (17-6x109/L, 90% neutrophils, 1% eosino-phils); high concentrations of total bilirubin, 75 umol/L, and creatinine, 0-34 mmol/L. Lactate dehydrogenase was 2500 U/L and free haemoglobin 8-05 g/L (normal <0-05 g/L), which indicated massive intravascular haemolysis. Our suspicion of autoimmune haemolytic anaemia with acute renal failure due to haemolysis was confirmed by a direct antiglobulin test that detected antibodies to IgG and complement C3d.