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Post-Babesiosis Warm Autoimmune Hemolytic Anemia
Ann E Woolley1, Mary W Montgomery1, William J Savage1
1From the Divisions of Infectious Diseases (A.E.W., M.W.M., K.D., S.V., J.H.M., F.M.M.), Transfusion Medicine (W.J.S.), and Hematology (M.O.A.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., M.W.M., W.J.S., M.O.A., J.H.M., F.M.M.), and Dana-Farber Cancer Institute (A.E.W., M.O.A., F.M.M.) - all in Boston.
The New England Journal of Medicine
|March 9, 2017
Summary
Babesiosis can lead to warm-antibody autoimmune hemolytic anemia (WAHA) in some patients, particularly those without a spleen. This condition requires further treatment, often immunosuppression.
Area of Science:
- Infectious Diseases
- Hematology
- Immunology
Background:
- Babesiosis is a tickborne zoonotic disease caused by protozoa.
- It typically presents with hemolytic anemia that resolves with treatment.
- Warm-antibody autoimmune hemolytic anemia (WAHA) post-babesiosis is not well-described.
Purpose of the Study:
- To investigate the occurrence of WAHA after babesiosis diagnosis and treatment.
- To identify risk factors for developing WAHA following babesiosis.
Main Methods:
- Retrospective cohort study of babesiosis patients from 2009-2016.
- Extracted data on hematologic complications within 3 months of babesiosis diagnosis.
- Analyzed patient records for development of WAHA.
Main Results:
- Six out of 86 babesiosis patients developed WAHA 2-4 weeks post-treatment.
- All affected patients were asplenic (P<0.001).
- Patients showed positive direct antiglobulin tests and identified warm autoantibodies.
Conclusions:
- Post-babesiosis WAHA can occur in patients without prior autoimmunity.
- Asplenic individuals are at higher risk for developing WAHA after babesiosis.
- WAHA may necessitate immunosuppressive treatment.
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