A rare case of complicated malaria presenting as warm autoimmune hemolytic anemia

Autoimmune hemolytic anemia (AIHA) has been rarely reported worldwide or from India as the underlying cause of anemia in malaria. We hereby present a case of complicated Plasmodium falciparum malaria with concomitant warm AIHA in a 31-year-old male. Direct Antiglobulin Test (DAT) was positive and elution studies showed pan-agglutination reaction. Clinico-hematological and serological follow-up of the patient was done post artesunate treatment until day 9. We suggest that it is important to establish the immune basis of anemia in malaria patients for guiding the treatment plan for the clinicians and providing packed red blood cell transfusion if required.

Non RhD isoimmunization causing severe hemolytic disease of fetus and newborn in Rh positive pregnancies: report of 2 cases with review of literature

Anti D immunoprophylaxis widespread use in antenatal patients has led to dramatic reduction in the rates of alloimmunization due to anti D, which is the most common Rh antibody causing severe Hemolytic Disease of Fetus and New born (HDFN). However, there has been increase in the rates of non Rh D antibodies causing alloimmunization in pregnant women and leading to moderate to severe HDFN. We hereby report two cases of neonates presenting with moderate to severe HDFN with strongly positive DAT due to Rh anti-c antibody in Rh-positive mothers. Thus, antenatal antibody screening should be done in all Rh-positive pregnant women to prevent the diagnostic delay of HDFN occurring due to Non anti-D isoimmunization in the fetus.

Hemoglobin Agenogi ‑ A rare abnormal beta globin chain variant.

Haemoglobin (Hb) Agenogi is clinically asymptomatic, rare β‑globin chain variant characterized by a substitution of glutamic acid by lysine at position 90 of β‑chain. It elutes in the C‑window on high‑performance liquid chromatography (HPLC). We report a 10‑year‑old male with easy fatigability, lethargy, pallor, and mild splenomegaly. Hematological parameters revealed microcytic hypochromic anemia and mildly raised red blood cells count, suggestive of thalassemia trait. On HPLC, a predominant peak was observed in the C‑window (82.6%) along with raised HbA2 level (9.3%). Based on these findings, a possibility of HbC disease/β‑thalassemia trait doubly heterozygous was considered. Family studies were advised. HPLC findings in father were suggestive of β‑thalassemia trait, while both his mother and brother had an abnormal peak in the C‑window of 42.7% and 40.8%, respectively, with elevated HbA2 values of 5% and 4.9%, respectively. Direct DNA sequencing revealed intervening sequences 1–5 (G → C) in father, confirming β‑thalassemia trait. His mother and brother had heterozygous gene mutation at codon 90 of β‑globin chain (G → A) suggestive of Hb Agenogi. The child carried mutations for both β‑thalassemia trait as well as Hb Agenogi.