Autoimmune Hemolytic Anemia as an Initial Manifestation of Splenic Marginal Zone Lymphoma

TL;DR

A case report describes a patient with autoimmune hemolytic anemia caused by an underlying lymphoma, highlighting the importance of thorough diagnosis.

Contribution

This case highlights AIHA as a rare initial sign of splenic marginal zone lymphoma, emphasizing the need for comprehensive evaluation.

Findings

Autoimmune hemolytic anemia was found to be secondary to splenic marginal zone lymphoma in a 49-year-old woman.

Treatment with steroids and rituximab was initiated following diagnosis.

Bone marrow biopsy and flow cytometry confirmed the lymphoma diagnosis.

Abstract

Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies that target and destroy the individual's own red blood cells (RBCs). Warm AIHA is due to antibodies that are active at body temperature and are the most common type of AIHA. Herein, we report a 49-year-old woman who presented with breathlessness, easy fatiguability, and palpitations with blood picture showing severe anemia requiring multiple blood transfusions, leucocytosis, Direct Coombs Test (DCT) positivity, and elevated lactate dehydrogenase (LDH). The patient later developed increasing leukocytosis, for which bone marrow biopsy and immunophenotyping using flow cytometry were done, confirming the presence of underlying splenic marginal zone lymphoma resulting in secondary AIHA. The patient was referred to the hematology department and was started on treatment with steroids and rituximab.