Auto-immune haemolytic anaemia in ulcerative colitis

Abstract

Auto-immune haemolytic anaemia (AIHA) is a rare complication of ulcerative colitis (UC) occurring in less than 1% of cases. We present a 48 year old man with UC involving an AIHA. Direct antiglobulin test (DAT) and indirect antiglobulin test (IAT) positive AIHA was established 7 months after diagnosis of UC, treated with sulphasalazine. AIHA occurred simultaneously with an aggravation of UC. Haemolytic crises were refractory to steroids, COP regimen (cyclophosphamide, vincristine, methylprednisolone) and splenectomy, respectively. Repeated administration of COP regimen following splenectomy led gradually to significant improvement of AIHA despite the persisting positivity of DAT and IAT. At the same time UC was under control. Clinical course of both diseases characterized occurrence of haemolytic crises after a cessation or reduction of immunosuppression. The problem was solved by continued administration of azathioprine with steroids in adequate doses. It seems that AIHA in this case reacted as an auto-immune event independent of the UC activity. Copyright © Hellenic Society of Haematology.