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Case Report
Refractory autoimmune hemolytic anemia secondary to Babesia
1 MD, Director of Blood Bank, Louisiana State University, Shreveport, LA, USA
2 MD, Resident, Louisiana State University, Shreveport, LA, USA
3 MD, Resident, Houston Methodist Hospital, Houston, TX, USA
4 MD, Associate Professor, University of South Alabama Health, Mobile, AL, USA
5 Professor, Louisiana State University, Shreveport, LA, USA
Address correspondence to:
James Cotelingam
Professor, Louisiana State University, Shreveport, LA,
USA
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Article ID: 100081Z02MO2024
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Ong M, Lee J, Deepika F, Wei EX, Cotelingam J. Refractory autoimmune hemolytic anemia secondary to Babesia. Int J Blood Transfus Immunohematol 2024;14(1):1–4.ABSTRACT
Introduction: Babesia is endemic in the northeast and upper midwestern United States. Two species that cause human infections are Babesia microti and Babesia divergens. The parasite is transmitted by the bite of the tick Ixodes scapularis. Another mode of transmission is blood transfusion producing either an asymptomatic to mild flu-like illness or hemolytic anemia in immunocompromised and asplenic individuals. Hemolysis is usually non-immune and attributed to lysis of infected erythrocytes. Rarely the infection may cause immune dysregulation and lead to the formation of autoantibodies that cause immune mediated hemolytic anemia.
Case Report: A previously healthy young adult male with a recent history of multiple blood transfusions, presented with refractory autoimmune hemolytic anemia within two months of transfusion. The anemia was unresponsive to various immunosuppressive medications and blood transfusions. On follow-up, his peripheral smears showed heavy parasitemia consistent with Babesia species. The organism was speciated to Babesia microti by polymerase chain reaction at the Center for Disease Control. The patient was treated with intravenous quinidine and oral clindamycin. Immune hemolytic anemia resolved following the treatment of Babesiosis.
Conclusion: In conclusion, Babesiosis should be in the differential diagnosis of autoimmune hemolytic anemia in a patient with a history of blood transfusion and poor response to steroids or immunosuppressive drugs.
Keywords: Autoimmune hemolytic anemia, Babesia, Refractory, Transfusion
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Acknowledgments
The authors would like to thank Samaly Souza and the CDC for PCR testing.
Author ContributionsMenchu Ong - Conception of the work, Design of the work, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Jennifer Lee - Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Fnu Deepika - Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Eric X Wei - Conception of the work, Design of the work, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
James Cotelingam - Conception of the work, Design of the work, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2024 Menchu Ong et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
