A Curious Case of Hemolytic Anemia with Pseudoreticulopenia

Area of Science:

• Hematology
• Immunology
• Internal Medicine

Background:

• Coombs-negative, steroid-refractory autoimmune hemolytic anemia (AIHA) is rare, accounting for <1% of AIHA cases.
• Diagnosis is challenging due to negative Coombs tests, often delaying treatment and increasing morbidity.

Observation:

• This study details a unique case of AIHA complicated by pseudoreticulopenia.
• The patient exhibited normal bone marrow function, complicating the diagnosis of reticulopenia.
• Pseudoreticulopenia was attributed to erythroid maturation defects caused by coexisting pernicious anemia.

Findings:

• The super-Coombs test can aid in diagnosing AIHA when traditional tests are negative.
• Rituximab is an effective second-line therapy for many AIHA cases.
• This is the first reported instance of pseudoreticulopenia in AIHA secondary to pernicious anemia.

Implications:

• Increased physician awareness of rare AIHA subtypes and pseudoreticulopenia is crucial for timely diagnosis.
• Recognizing the interplay between AIHA and pernicious anemia can improve patient outcomes.
• Prompt diagnosis and treatment of AIHA, even in complex cases, are vital to reduce morbidity.