A Pediatric Case of Autoimmune Hemolytic Anemia followed by Excessive Thrombocytosis and Leukocytosis

Abstract

Autoimmune hemolytic anemia (AIHA) is characterized by the production of antibodies directed against red blood cells (RBCs). It is usually accompanied by normal white blood cell (WBC) and platelet counts. Severe leukocytosis and thrombocytosis in AIHA are rare. Here, we report a 3-year-old female child who showed AIHA by warm antibody testing with both leukocytosis and thrombocytosis. The patient was treated with oral steroids for 5 days. During treatment, the leukocytosis was noted on hospital day 3 and was up to 60.87×10 9 /L. In addition, the thrombocytosis persisted at up to 725×10 9 /L. After day 7, the WBC and platelet counts returned to the normal range.

Hemolytic Anemia and Reactive Thrombocytosis Associated With Cefoperazone/Sulbactam

“…(Tefferi, 2018) A pediatric patient with AIHA was reported to show thrombocytosis. (Jea et al, 2007) Kobayashi et al reported that ribavirin treatment in chronic hepatitis C patients induced anemia and may have led to increases in endogenous serum erythropoietin that in turn resulted in the stimulation of platelet production. (Kobayashi et al, 2012) During cefoperazone/sulbactam therapy and withdrawal, the patient’s platelets showed an opposite change tendency compared to hemoglobin, RBCs, and hematocrit ( Figure 1 ), suggestive of reactive thrombocytosis due to hemolytic anemia.…”

Granulomatosis with Polyangiitis Presenting as Pyrexia of Unknown Origin, Leukocytosis, and Microangiopathic Haemolytic Anemia

“…In our patient, a possible mechanism for the observed leukocytosis could be as a response to extreme physiologic stress causing a profound inflammatory response and upregulating the immune system. Additionally, stimulation of bone marrow, such as that seen in haemolytic anemia, can rarely precipitate significant leukocytosis, possibly via overstimulation of the bone marrow in response to the anemia [ 17 ].…”