AUTOIMMUNE HEMOLYTIC ANEMIA IN A 7-YEAR OLD PATIENT WITH ULCERATIVE COLITIS

Key words: Autoimmune hemolytic anemia, Ulcerative colitis, Cyclosporine, Azathioprine, Mesalazine

We report a case of a 7 year-old patient with a 4-year history of severe steroid-refractory Ulcerative Colitis (UC) which had been controlled with cyclosporine and azathioprine, who was admitted to our Clinic because of jaundice. At time of admission mild intestinal bleeding was occasionally present on azathioprine and mesalazine. Investigations revealed hyperbilirubinemia, Coombs-positive haemolytic anemia (AIHA) (Hb 7.5 g/dl). IVIG (1 g/kg/day for 3 days) and oral prednisone (2 mg/kg/day) were prescribed with clinical improvement. Four weeks later, while on oral steroids (1 mg/kg/day) and azathioprine, a new haemolytic crisis occurred (Hb 6.7 g/dl) refractory to IVIG (1 g/kg/day for 3 days) and metylprednisolone pulses. Colonoscopy showed active mucosal lesions. Oral cyclosporine was then introduced with complete remission of GI bleeding and partial improvement of AIHA; after 6 months, controlled chronic haemolisis and positive Coombs test persist with mild anaemia.