Mixed Warm and Cold Autoimmune Hemolysis in an Elderly Patient With Sickle Cell Disease and End-Stage Renal Disease on Hemodialysis: A Diagnostic and Therapeutic Challenge

TL;DR

An elderly patient with sickle cell disease and kidney failure faced a rare and complex blood disorder requiring careful treatment.

Contribution

Highlights diagnostic and therapeutic challenges of mixed AIHA in elderly SCD patients with ESRD.

Findings

Mixed AIHA is rare in elderly SCD patients and presents diagnostic difficulties.

Corticosteroids and multidisciplinary care helped stabilize the patient despite transfusion challenges.

Alloimmunization complicates transfusion support in such complex cases.

Abstract

Mixed autoimmune hemolytic anemia (AIHA), defined by the simultaneous presence of warm and cold autoantibodies, is a rare and severe complication in patients with sickle cell disease (SCD), particularly in older adults. This case describes a male in his late 60s with homozygous SCD and end-stage renal disease (ESRD) who developed mixed AIHA, presenting with profound anemia and laboratory evidence of hemolysis. The advanced age and comorbidities complicated both diagnosis and management, with transfusion support hindered by alloimmunization. Despite these challenges, corticosteroid therapy and multidisciplinary care contributed to clinical stabilization. This case underscores the need for heightened clinical suspicion and tailored management strategies for mixed AIHA in elderly SCD patients.