Clinical Case Database / Category: Patient Management

A case of mixed warm and cold autoimmune haemolytic anaemia

Publication details

Dr Angela S Clarke, CMT1, Dr Jonathan O Cullis
Foundation Years Journal, volume 9, issue 3, p.6 (123Doc Education, London, March 2015)


Anaemia is a common finding in patients admitted to hospital and results from either failure of red cell production, or from increased red cell destruction or loss. We present a rare case of mixed cold and warm autoimmune haemolytic anaemia. The patient's presentation, initial findings and more specialised investigations are discussed, along with management of the case and complexities of the diagnosis.

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Dr Angela S Clarke, CMT1

Salisbury NHS Foundation Trust
Salisbury, Wiltshire, SP2 8BJ

Dr Jonathan O Cullis (Corresponding author)

Consultant Haematologist
Salisbury NHS Foundation Trust, Salisbury, Wiltshire, SP2 8BJ


1. Crowther M, Chan YLT, Garbett IK , et al. Evidence-based focused review of the treatment of idiopathic warm immune hemolytic anemia in adults. Blood 2011, 118:4036-40.
2. Lechner K & Jäger U. How I treat autoimmune hemolytic anemias in adults. Blood 2010, 116:1831-8
3. Zanella A & Barcellini W. Treatment of autoimmune hemolytic anemias. Haematologica 2014, 99:1547-54.
4. Swiecicki PL, Hegerova LT & Gertz MA. Cold agglutinin disease. Blood 2013, 122:1114-21.
5. Berentsen S. How I treat cold agglutinin disease. Brit J Haematol 2011, 153:309-17.
6. Morselli M, Luppi M, Potenza L et al. Mixed warm and cold autoimmune hemolytic anemia: complete recovery after 2 courses of rituximab treatment. Blood 2002, 99:3478-9.
7. Webster D, Ritchie B & Mant MJ. Prompt response to rituximab of severe hemolytic anemia with both cold and warm autoantibodies. Am J Hematol 2004, 75:258-9.
8. Gupta S, Szersen A, Nakhl F et al. Severe refractory autoimmune hemolytic anemia with both warm and cold autoantibodies that responded to a single cycle of rituximab: a case report. J Med Case Rep 2011, 5:156-60.
9. Montagnani S, Tuccori M, Lombardi G et al. Autoimmune haemolytic anaemia following MF59-adjuvanted influenza vaccine administration: a report of two cases. Ann Pharmacother 2011, 45:e8.
10. Shlamovitz GZ & Johar S. A case of Evans' syndrome following influenza vaccine. J Emerg Med 2013, 44:e149-51.
11. Shizuma T. Autoimmune hemolytic anemia following influenza virus infection or administration of influenza vaccine. J Blood Disorders Transf 2014, 5:200.


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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