Mejia Buritica Leonardo, Zapata Alvarez Jesus, Vergara Quintero Lissette, Villegas Molina Juan Pablo, Torres Hernandez José Domingo
Department of Hematology, Universidad de Antioquia, Medellin, COL.
Department of Internal Medicine, Universidad de Antioquia, Medellin, COL.
Cureus. 2020 Oct 5;12(10):e10797. doi: 10.7759/cureus.10797.
Pernicious anemia (PA) is associated with other autoimmune diseases, such as hypothyroidism, type 1 diabetes mellitus (DM1), Addison's disease, and vitiligo. The association between PA and autoimmune hemolytic anemia (AIHA) is rare, with less than 30 cases reported in the literature. In this paper, we report a case of a patient with a confirmed diagnosis of PA, who, six months after starting treatment with cyanocobalamin, presented with severe hemolysis with a positive direct antiglobulin test (DAT) for warm antibodies; the patient responded well to glucocorticoid treatment. AIHA in PA patients can be triggered by cyanocobalamin replacement due to the expression of membrane antigens by mature red blood cells entering into the peripheral circulation. This association should be considered because these patients, in addition to cyanocobalamin replacement, will require immunosuppressive treatment, usually with glucocorticoids.
恶性贫血（PA）与其他自身免疫性疾病相关，如甲状腺功能减退、1型糖尿病（DM1）、艾迪生病和白癜风。PA与自身免疫性溶血性贫血（AIHA）之间的关联较为罕见，文献报道的病例不足30例。在本文中，我们报告了一例确诊为PA的患者，该患者在开始使用氰钴胺治疗六个月后，出现严重溶血，直接抗球蛋白试验（DAT）显示温抗体阳性；患者对糖皮质激素治疗反应良好。PA患者发生AIHA可能是由于进入外周循环的成熟红细胞表达膜抗原，从而引发氰钴胺替代治疗。应考虑到这种关联，因为这些患者除了进行氰钴胺替代治疗外，通常还需要免疫抑制治疗，一般使用糖皮质激素。
