CASE I. AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)
A. TYPE II AUTOIMMUNE REACTION
On the basis of these clinical findings, the diagnoses of AIHA and thrombocytopenia were made. She was treated with prednisone. Initially her platelet count improved to 120,000. However, after three months of treatment, her anemia did not improve. She gained twenty pounds and noted easy bruising, fatigue and difficulty sleeping as well as “feeling on edge all the time”. since she had not improved and was experiencing side effects of prednisone, she was given a penumococcal pneumonia vaccination before surgery to remove her spleen. After splenectomy, her anemia, thrombocytopenia, and some of her fatigue resolved. After tapering the prednisone dose, she felt “felt normal”. Two years later, her symptoms recurred and laboratory tests confirmed evidence of active hemolytic anemia. A liver-spleen scan indicated the presence of an accessory spleen (present in 10-30% of normal population), which was removed. She is currently symptom free.