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Haematology
Diagnostic challenges in DAT-negative autoimmune haemolytic anaemia
  1. Laura McDuff1,
  2. Marcus Lombard2,3,
  3. Tony Calogero2,
  4. Michael Leahy2 and
  5. Susan Finch4
  1. 1Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Haematology, Royal Perth Hospital, Perth, Western Australia, Australia
  3. 3Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  4. 4Transfusion Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Laura McDuff; laura.mcduff{at}health.wa.gov.au

Abstract

Autoimmune haemolytic anaemia (AIHA) is a rare, heterogeneous condition that poses diagnostic challenges, especially in direct antiglobulin test (DAT)-negative cases, where the absence of detectable autoantibodies complicates diagnosis. We report a case of a male patient in his late 60s diagnosed with a rare subtype of IgA-mediated, DAT-negative AIHA. The patient presented with painless jaundice, pruritus and laboratory evidence of haemolysis, including anaemia, reticulocytosis, elevated unconjugated bilirubin, increased lactate dehydrogenase and decreased haptoglobins. Initial and repeated standard DATs were negative. Subsequent testing ruled out viral, autoimmune and malignancy-related causes. An extended DAT using alternative reagents for IgA and IgM confirmed an IgA-mediated AIHA. Further investigations later confirmed the diagnosis of an indolent lymphoproliferative disorder following detection of a clonal B-cell population in the peripheral blood. This case underscores the diagnostic complexity of AIHA and the value of a comprehensive diagnostic approach to finding cases of rare DAT-negative subtypes.

  • Autoimmunity
  • Haematology (incl blood transfusion)

https://doi.org/10.1136/bcr-2024-264551

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    Footnotes

    • Contributors LM was responsible for the acquisition and interpretation of data, writing and preparation of the manuscript and was involved in reviewing and editing the manuscript. MLo contributed to the conceptualisation of the work, acquisition of data and provided critical reviews of the manuscript. TC contributed to data acquisition, obtained formal written consent from the patient and critically reviewed the manuscript. MLe contributed to the conceptualisation of the work and critically reviewed the manuscript. All authors have read and agreed to the published version of the manuscript. SF is acknowledged for her central role in conducting the investigations and her pivotal contribution in diagnosing the patient’s condition. Her expertise was crucial in identifying the underlying disorder and shaping the clinical approach in this case report. Guarantor: LM. Grammarly (Edu) was used to provide formatting, grammar and language suggestions based on the draft manuscript with specific reference to syntax, punctuation, use of passive voice, word choice/synonym suggestion and consistency of spelling and language. AI use for language editing of the work was reviewed by the authors to ensure information was conveyed appropriately and readability. All original content of the case report was written by the authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.