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25 February 2022: Articles

Autoimmune Hemolytic Anemia – Rare Complication of Brucellosis in a Saudi Woman: A Case Report and Literature Review

Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology

Islam A. Ibrahim A* , Wesam R. Dause A , Osama M. Estaitieh A , Reem A. AlQunfoidi A , Mohannad Talat Howladar A

DOI: 10.12659/AJCR.935187

Am J Case Rep 2022; 23:e935187

Table 1. Patient blood work on admission, 7 days after initiation of antibiotics and 3 days after initiation of prednisolone and IVIG.

Investigation/time (normal range)On admissionAfter 7 days antibioticsAfter 3 days of initiation of prednisolone and IV.IG
WBC (3.3–10.8 ×10)3×102.3×104.8×10
HGB (13.5–17.5 g/dL)8.1 g/dL9.2 g/dL10.8 g/dL
MCV: MCH (80–100): (23.7–32)[54.6FL]: [32.3PG][59.5FL]: [32.2PG][61FL]: [32PG]
Platelet (150–500×10)13×109×1069×10
Reticulocytes #:% (0.02–0.1): (0.2–2)[0.085×10]: [1.96%]4.2%
Peripheral blood smearAnisopoikilocytosis, microcytosis and hypochromia.Acanthocytosis and schistocytes.Neutropenia Dimorphic morphology 2% of Schistocytes No immature cellsNo schistocytes
Random blood glucose (3.9–8.3 mmol/L)5.58 mmol/L5.4 mmol/L6.3
Urea (1.7–8.3 mmol/L)1 mmol/L2.6 mmol/L2.5
Creatinine (44–80 µmol/L)40 µmol/L40 µmol/L49
Sodium (135–147 mmol/L)128 mmol/L137 mmol/L134
Potassium (3.5–5.1 mmol/L)3.11 mmol/L4.03 mmol/L4.81
Chloride (98–106 mmol/L)97 mmol/L97 mmol/L94
CO (22–29 mmol/L)18 mmol/L28 mmol/L26 mmol/L
AST (5–32 U/L)73 U/L
ALT (5–35 U/L)44 U/L29 U/L10 U/L
ALP216 U/L350 U/L226 U/L
Calcium (2.15–2.55 mmol/L)1.94 mmol/L
Protein total (64–83 g/L)74 g/L
Albumin (34–48 g/L)30.4g/L33g/L35g/L
Lactate dehydrogenase (135–214 U/L)279 U/L825 U/L
Haptoglobin0.1 g/L
Ferritin serum (30–150 µg/L)359.4 µg/L
Transferrin (2–4 g/L)2.54 g/L
% Saturation (20–50%)6.9%
Iron serum (6.6–26 µmol/L)4.4 µmol/L
Folate (10.4–42.4 nmol/L)28.28 nmol/L
Vitamin B12 (179–660 pmol/L)312.1 pmol/L
Blood cultureBrucella isolatedNo growth
Sputum for AFBNegative
Sputum MTB-PCRNot detected
Sputum CultureNo growth
Malaria ScreenNegative
Bone marrow cultureNegative
HIVNegative
HBsAgNegative
HCV-AntibodiesNegative
EBV IgM: IgGNonreactive: Reactive
CMV IgM: IgGNonreactive: Reactive
Brucella melitensisPositive at 1: 1,280
Brucella abortusPositive at 1: 640
Leishmania Antibody
Bone marrow aspirate and biopsy
CRP (0.425–5 mg/L)94.6 mg/L10.2 mg/L4.8 mg/L
Haptoglobin (0.3–2 g/L)2.14 g/L
Lupus anticoagulantNegative

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923