Comprehensive management of immune-related hemolytic anemia in a patient with acute cholangitis: A case report

Immune-associated hemolytic anemia is an uncommon and potentially life-threatening complication in patients with choledocholithiasis and acute cholangitis. Its occurrence during the perioperative period remains rarely reported.

A 69-year-old woman presented with right upper abdominal pain and was diagnosed with choledocholithiasis and acute cholangitis. During hospitalization, she developed sudden confusion and shock, with her hemoglobin rapidly declining to 26 g/L.

The patient was diagnosed with acute cholangitis and immune-related hemolytic anemia based on clinical manifestations and a positive direct antihuman globulin (Coombs) test.

The patient received high-dose glucocorticoid therapy combined with red blood cell transfusion, followed by endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and nasobiliary drainage to relieve biliary obstruction, and subsequent laparoscopic cholecystectomy.

After timely diagnosis and comprehensive management, the patient's hemoglobin stabilized, hemolysis resolved, and she recovered without postoperative complications.

This case provides 3 important lessons for clinical practice: The need for prompt recognition and management of unexpected perioperative complications and flexible adjustment of clinical thinking. A systematic approach for handling sudden and life-threatening hemoglobin decline. Appropriate timing and optimal surgical strategy selection for delayed definitive surgery after stabilization.