Case 68 – update 1

So far we have found out our 36 year old lady has been tired for a few weeks. She has no history of weight loss or night sweats. She has not lost any weight or noted any lumps or bumps. She has a family history of SLE with a sister who is affected. She is a lifelong non smoker and drinks around 12 units of alcohol a week. She is normally fit and well and has never been transfused. She takes no regular medications.

Blood tests have shown anaemia Hb 67 with borderline high retic count 100 (normal 50-100) low haptoglobins, high LDH 600 (normal 200-450), Bili 70. Blood film shows prominent spherocytes and occasional echinocytes. DAT is positive for Ig G and C3. Direct agglutination test is negative excluding a cold element to the haemolysis. 

There were no features of PCH in the history and the lack of a drug history and transfusion history make Drug induced or transfusion related Haemolysis unlikely. The team think she has warm Haemolysis and given she has symptomatic anaemia they arrange blood transfusion.

How would you treat this lady?

What medications should be considered as adjuncts to any Haemolysis patients care?

How common is thrombosis in warm Haemolysis? 

Should she be on LMWH prophylaxis? 

Are there any tests that would help establish if primary or secondary Warm Haemolysis? 

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