Low haptoglobin and a positive direct antiglobulin test without haemolysis in pregnancy

Haemolysis is typically associated with low haptoglobin and elevated reticulocyte count, lactate dehydrogenase and indirect bilirubin. Positive direct antiglobulin testing is consistent with autoimmune haemolysis. A case of anaemia in pregnancy with low haptoglobin levels and positive direct antiglobulin testing in a woman with systemic lupus erythematosus is presented. The lack of response to intravenous immune globulin and absence of other markers of haemolysis prompted further investigation. In the setting of mild renal dysfunction, the woman's serum erythropoietin was inappropriately low consistent with a failure of erythropoietin response to anaemia, and the woman's haemoglobin improved rapidly with darbopoietin therapy. darbepoetin Health professionals need to be aware of the possibility of low haptoglobin and positive direct antiglobulin testing in the absence of haemolysis with autoimmune disease and anticardiolipin antibodies, and the possibility of anaemia due to failure of erythropoietin response with mild renal dysfunction in pregnancy.