@article {4740,
	title = {Acute autoimmune hemolytic anemia due to anti-Ena autoantibody},
	volume = {58},
	year = {2018},
	month = {Jan},
	pages = {76},
	abstract = {BACKGROUND:

Autoimmune hemolytic anemia (AIHA) due to anti-Ena has been previously reported in association with massive intravascular hemolysis, disseminated intravascular coagulation, and fatal outcomes. Here we report a case of successfully treated AIHA due to anti-Ena .
CASE REPORT:

A 69-year-old male with a past medical history of cirrhosis due to nonalcoholic steatohepatitis status post-orthotopic liver transplant presented with 1-month history of progressive anemia. At presentation, his hemoglobin (Hb) was 5.6 g/dL, hematocrit (Hct) 16\%, reticulocytes 0.3\%, direct bilirubin (bili) 4 g/dL, lactate dehydrogenase 533 units/L (reference, 125-220 units/L), and haptoglobin 254 mg/dL (reference, 40-273 mg/dL). Blood bank testing revealed an autoantibody present in his plasma and a direct antiglobulin test positive for immunoglobulin G (IgC) but negative for complement. He received 1 unit of an incompatible blood group O phenotypically matched red blood cell unit.
RESULTS:

Over the course of the next 5 days, the Hb and Hct decreased to 4.1 g/dL and 12\%, respectively, direct bili increased to 12.3 mg/day, reticulocytes slightly increased to 0.9\%, and haptoglobin decreased to less than 8 mg/dL. Marrow study showed a hypercellular marrow with erythroid hyperplasia. Additional workup performed at a reference laboratory identified an anti-Ena autoantibody. He received prednisone and weekly rituximab infusions and was monitored weekly. At the 2-month visit, Hb and Hct were 10 g/dL and 32\%, respectively.
CONCLUSION:

Unlike two of the previously reported fatal cases of AIHA with anti-Ena specificity, this 69-year-old male treated with weekly rituximab infusion underwent clinical recovery and significant anemia improvement.},
	doi = {10.1111/trf.14363},
	author = {Nedelcu, E and Desai, M and Green, J and Bensing, KM and Turner, A and Head, D and Young, PP}
}
