Department of Cardiology, Shanghai East Hospital,Shanghai Tongji University School of Medicine, Shanghai, China.
BMC Cardiovasc Disord. 2020 Mar 4;20(1):106. doi: 10.1186/s12872-020-01401-8.
PE (pulmonary embolism) is a life-threatening complication rarely seen in the AIHA (autoimmune haemolytic anaemia) patients. Herein we reported a rare and serious AIHA-PE patient characterised by extensive peripheral pulmonary embolism on CTPA.
A 59-year-old woman presented to our ED (emergency department) complaining of acute chest pain and dyspnea. During her presentation in ED she experienced a sudden syncope and soon developed CA (cardiac arrest). Laboratory studies showed a increase of CK-MB,troponin T,myoglobin and D-dimer. Computed tomography pulmonary angiography (CTPA) showed no large central or segment pulmonary emboli but increased RV (right ventricle)size,enlarged main pulmonary artery and invisible peripheral pulmonary artery. She was diagnosed with acute PE and alteplase was delivered intravenously. After thrombolytic therapy she remained hypotension and developed worsening anaemia. Detailed examination for anaemia revealed AIHA. She was discharged in a stable condition after 5 weeks with methylprednisolone and warfarin. Hb, D-dimer and transthoracic echocardiography showed complete recovery at 3-months follow up.
PE attributed to AIHA is characterized by subsegment and distal pulmonary artery embolism which is easily neglected but always life-threatening. This case also highlights the PE as a secondary diagnosis should be evaluated comprehensively in order to identify the underlying pathogenesis.
PE（肺栓塞）是 AIHA（自身免疫性溶血性贫血）患者罕见的危及生命的并发症。在此，我们报告了一例罕见且严重的 AIHA-PE 患者，其 CTPA 表现为广泛的外周性肺栓塞。
一名 59 岁女性因急性胸痛和呼吸困难到我院急诊科就诊。在急诊科就诊期间，她突然晕厥并很快发生心脏骤停。实验室检查显示 CK-MB、肌钙蛋白 T、肌红蛋白和 D-二聚体升高。计算机断层扫描肺动脉造影（CTPA）显示无大的中央或节段性肺栓塞，但 RV（右心室）增大、主肺动脉扩大和看不见的外周肺动脉。她被诊断为急性 PE，并静脉内给予阿替普酶。溶栓治疗后，她仍低血压并出现贫血恶化。对贫血的详细检查发现为 AIHA。她在接受甲基强的松龙和华法林治疗 5 周后稳定出院。Hb、D-二聚体和经胸超声心动图在 3 个月随访时显示完全恢复。
由 AIHA 引起的 PE 表现为亚段和远端肺动脉栓塞，容易被忽视，但总是危及生命。本例还强调了 PE 作为次要诊断，应全面评估以确定潜在的发病机制。
