Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2016 Jan 14:2016:bcr2015213575.
doi: 10.1136/bcr-2015-213575.

Adding insult to injury: autoimmune haemolytic anaemia complicated by pulmonary embolism

Kevin Andrew Woodson  1 , Yungah Lee  2 , Kavitha Gopalratnam  1 , Stephanie Halene  3
Affiliations
Case Reports

Adding insult to injury: autoimmune haemolytic anaemia complicated by pulmonary embolism

Kevin Andrew Woodson et al. BMJ Case Rep. .

Abstract

Autoimmune haemolytic anaemia (AIHA) is a disease characterised by the production of pathological antibodies that attach to the surface of a patient's own red blood cells, resulting in haemolysis. It can present in either an acute or a chronic manner. In addition to the obvious consequence of anaemia, there are other potentially deadly complications that can arise from AIHA, such as venous thromboembolism (VTE) and pulmonary hypertension. We report a case of a 52-year-old woman who developed a pulmonary embolism (PE) soon after being diagnosed with AIHA. Despite having a very small pulmonary venous clot burden, she developed profound haemodynamic compromise with severe right ventricular dysfunction, which quickly reversed with inhaled nitric oxide treatment. This case makes an interesting observation of cell-free haemoglobin-associated nitric oxide scavenging as a mechanism of pulmonary hypertension and highlights the possible benefit of nitric oxide in treatment.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CTof the chest and angiogram revealed small bilateral subsegmental pulmonary emboli.
Figure 2
Figure 2
Short-axis view of the patient's echocardiogram on presentation demonstrating septal wall flattening causing ‘D’-shaped left ventricle. This finding is consistent with right ventricle pressure overload. Image was captured during diastole.
Figure 3
Figure 3
Short-axis view of the patient's echocardiogram after nitric oxide treatment demonstrating resolution of the septal wall flattening. Image was captured during diastole.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bottiger LE, Westerholm B. Acquired haemolytic anaemia. I. Incidence and aetiology. Acta Med Scand 1973;193:223–6. - PubMed
    1. Apfaltrer P, Henzler T, Meyer M et al. . Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Eur J Radiol 2012;81:2867–71. 10.1016/j.ejrad.2011.08.014 - DOI - PubMed
    1. Rodrigues B, Correia H, Figueiredo A et al. . [Clot burden score in the evaluation of right ventricular dysfunction in acute pulmonary embolism: quantifying the cause and clarifying the consequences]. Rev Port Cardiol 2012;31:687–95. 10.1016/j.repc.2012.02.020 - DOI - PubMed
    1. Allgood JW, Chaplin H Jr. Idiopathic acquired autoimmune hemolytic anemia. A review of forty-seven cases treated from 1955 through 1965. Am J Med 1967;43:254–73. 10.1016/0002-9343(67)90168-4 - DOI - PubMed
    1. Ataga KI. Hypercoagulability and thrombotic complications in hemolytic anemias. Haematologica 2009;94:1481–4. 10.3324/haematol.2009.013672 - DOI - PMC - PubMed

MeSH terms

Substances