Primary IgA-mediated Autoimmune Hemolytic Anemia in an Infant Successfully Treated With Rituximab.

Autoimmune hemolytic anemia (AIHA) is uncommon in the pediatric population and is often associated with an infectious etiology or postvaccination. Mostly, the child presents with a positive direct antiglobulin test. The diagnosis can be challenging, as in our case with an immunoglobulin A-mediated AIHA. In addition to supportive therapy, such as a red blood cell transfusion, steroids are the first choice of treatment. Rituximab, as second-line treatment, can be given in conjunction. We report the first case of immunoglobulin A-mediated AIHA treated with rituximab in the literature.

Thrombocytopenia in severe iron deficiency anemia in children.

AIM: Iron deficiency anemia (IDA) is common in the pediatric population and often accompanied by mild thrombocytosis, but rarely profound thrombocytopenia is seen. We describe the data of children with IDA and thrombocytopenia in two centers and discuss the published data in the literature. METHODS: In this retrospective case series, the medical records of patients under the age of 19 years old diagnosed with IDA in two tertiary medical centers over the last 10 years, were reviewed. The data were collected and compared to the data published in the medical literature. RESULTS: All the patients presented with severe IDA and thrombocytopenia improved with iron treatment. Although none of the patients had signs of major bleeding, the thrombocytopenia could mostly be classified as severe (platelet count <50×10E9/L). Due to the severity of the anemia, in about half of the cases, a red blood cell transfusion was given. The peak of the platelet count was seen in the first month after the start of iron treatment. In eight cases of children with IDA, the thrombocytopenia appeared after the supplementation of iron was started. CONCLUSION: Clinically stable children with severe IDA and thrombocytopenia, where other causes are very unlikely, warrant an empiric monotherapy with iron to prevent unnecessary investigations and treatments.