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 ADOI: 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 admission | After 7 days antibiotics | After 3 days of initiation of prednisolone and IV.IG |
---|---|---|---|
WBC (3.3–10.8 ×10) | 3×10 | 2.3×10 | 4.8×10 |
HGB (13.5–17.5 g/dL) | 8.1 g/dL | 9.2 g/dL | 10.8 g/dL |
MCV: MCH (80–100): (23.7–32) | [54.6FL]: [32.3PG] | [59.5FL]: [32.2PG] | [61FL]: [32PG] |
Platelet (150–500×10) | 13×10 | 9×10 | 69×10 |
Reticulocytes #:% (0.02–0.1): (0.2–2) | [0.085×10]: [1.96%] | 4.2% | – |
Peripheral blood smear | Anisopoikilocytosis, microcytosis and hypochromia.Acanthocytosis and schistocytes. | Neutropenia Dimorphic morphology 2% of Schistocytes No immature cells | No schistocytes |
Random blood glucose (3.9–8.3 mmol/L) | 5.58 mmol/L | 5.4 mmol/L | 6.3 |
Urea (1.7–8.3 mmol/L) | 1 mmol/L | 2.6 mmol/L | 2.5 |
Creatinine (44–80 µmol/L) | 40 µmol/L | 40 µmol/L | 49 |
Sodium (135–147 mmol/L) | 128 mmol/L | 137 mmol/L | 134 |
Potassium (3.5–5.1 mmol/L) | 3.11 mmol/L | 4.03 mmol/L | 4.81 |
Chloride (98–106 mmol/L) | 97 mmol/L | 97 mmol/L | 94 |
CO (22–29 mmol/L) | 18 mmol/L | 28 mmol/L | 26 mmol/L |
AST (5–32 U/L) | 73 U/L | – | – |
ALT (5–35 U/L) | 44 U/L | 29 U/L | 10 U/L |
ALP | 216 U/L | 350 U/L | 226 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/L | 33g/L | 35g/L |
Lactate dehydrogenase (135–214 U/L) | 279 U/L | 825 U/L | – |
Haptoglobin | – | 0.1 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 culture | Brucella isolated | – | No growth |
Sputum for AFB | Negative | ||
Sputum MTB-PCR | Not detected | ||
Sputum Culture | No growth | ||
Malaria Screen | Negative | ||
Bone marrow culture | Negative | ||
HIV | Negative | ||
HBsAg | Negative | ||
HCV-Antibodies | Negative | ||
EBV IgM: IgG | Nonreactive: Reactive | ||
CMV IgM: IgG | Nonreactive: Reactive | ||
Brucella melitensis | Positive at 1: 1,280 | ||
Brucella abortus | Positive at 1: 640 | ||
Leishmania Antibody | |||
Bone marrow aspirate and biopsy | |||
CRP (0.425–5 mg/L) | 94.6 mg/L | 10.2 mg/L | 4.8 mg/L |
Haptoglobin (0.3–2 g/L) | 2.14 g/L | ||
Lupus anticoagulant | Negative |