Tuberculosis induced autoimmune haemolytic anaemia: A systematic review to find out common clinical presentations, investigation findings and the treatment options

Abstract

Background: Tuberculosis induced autoimmune haemolytic anaemia is a rare entity. The aim of this study was to explore its common presentations, investigation findings and treatment options through a systematic review of published reports. Methods: PubMed, Trip, Google Scholar, Science Direct, Cochrane Library, Open-Grey, Grey literature report and the reference lists of the selected articles were searched for case reports in English on tuberculosis induced auto-immune haemolytic anaemia. PRISMA statement was used for systematic review. Quality assessment of the selected reports was done using the CARE guidelines. Results: Twenty-one articles out of 135 search results were included. Thirty-three percent of patients were reported from India. More than half had fever and pallor. The mean haemoglobin was 5.77 g/dl (SD 2.2). Positive direct coombs test was seen in all patients. Pulmonary tuberculosis (43%) was most prevalent. Twenty-nine percent of patients needed a combination of anti-tuberculosis medicines, blood transfusion and steroids. Higher percentage of disseminated TB induced AIHA (67%) needed steroids in comparison to the other types of TB induced AIHA (13%). Conclusions: Rarer complications of tuberculosis such as auto-immune haemolytic anaemia should be looked for especially in disease-endemic areas. Blood transfusion and steroids are additional treatment options along with the anti-tuberculosis medicines.