[Autoimmune hemolytic anemia, infrequent complication of ulcerative colitis]

Autoimmune hemolytic anemia is a rare complication of ulcerative colitis. A retrospective review of the cases of ulcerative colitis treated at our hospital between January 1984 and August 1993 showed that, among 210 patients, three presented autoimmune hemolytic anemia with a positive direct Coomb's test. They were two men and one woman suffering from a moderately active ulcerative colitis that affected the left colon. The hemolysis was diagnosed before the onset of colitis in two cases and after it in the other. In the only patient treated with sulphasalazine, this drug was stopped without improvement. All the patients were treated with steroids, with resolution of the anemia in one of them. Healing was achieved with splenectomy in the other two. Colectomy was not necessary in any case. After suppression of sulphasalazine and treatment with steroids, the next therapeutic option in patients with ulcerative colitis and autoimmune hemolytic anemia should be splenectomy, whereas colectomy should be only used with unresponsive patients, as well as with those affected by severe ulcerative colitis refractory to steroids. In patients presenting with ulcerative colitis and anemia, the possibility of autoimmune hemolytic anemia has to be considered since--in spite of being rare--it is responsive to proper treatment.