Acute peripheral pulmonary embolism attributed to autoimmune haemolytic anaemia: a case report

Abstract

Background: PE (pulmonary embolism) is a life-threatening complication rarely seen in the AIHA (autoimmune haemolytic anaemia) patients. Herein we reported a rare and serious AIHA-PE patient characterised by extensive peripheral pulmonary embolism on CTPA. Case presentation: A 59-year-old woman presented to our ED (emergency department) complaining of acute chest pain and dyspnea. During her presentation in ED she experienced a sudden syncope and soon developed CA (cardiac arrest). Laboratory studies showed a increase of CK-MB,troponin T,myoglobin and D-dimer. Computed tomography pulmonary angiography (CTPA) showed no large central or segment pulmonary emboli but increased RV (right ventricle)size,enlarged main pulmonary artery and invisible peripheral pulmonary artery. She was diagnosed with acute PE and alteplase was delivered intravenously. After thrombolytic therapy she remained hypotension and developed worsening anaemia. Detailed examination for anaemia revealed AIHA. She was discharged in a stable condition after 5 weeks with methylprednisolone and warfarin. Hb, D-dimer and transthoracic echocardiography showed complete recovery at 3-months follow up. Conclusion: PE attributed to AIHA is characterized by subsegment and distal pulmonary artery embolism which is easily neglected but always life-threatening. This case also highlights the PE as a secondary diagnosis should be evaluated comprehensively in order to identify the underlying pathogenesis.

Thromboembolism Early After Glucocorticoid Administration in Patients with Autoimmune Hemolytic Anemia

“…Although cases of splenic venous thrombosis, cerebral infarction, and acute coronary syndrome have also been reported [ 6 – 11 , 17 ], most thromboembolisms in patients with AIHA are PE/DVT. Regarding PE, it has been reported to affect mainly pulmonary distal vessels like on patient 3 [ 20 , 21 , 30 ]. Concurrent PE might exacerbate clinical outcomes in patients with AIHA with severe right ventricular dysfunction, such as sudden death [ 19 ], hemodynamic compression [ 20 ], and cardiac arrest [ 21 ].…”

“…Regarding PE, it has been reported to affect mainly pulmonary distal vessels like on patient 3 [ 20 , 21 , 30 ]. Concurrent PE might exacerbate clinical outcomes in patients with AIHA with severe right ventricular dysfunction, such as sudden death [ 19 ], hemodynamic compression [ 20 ], and cardiac arrest [ 21 ]. In addition, as distal PE may be easily missed [ 21 ], an imaging study should be performed.…”

“…Pulmonary embolism (PE) and deep venous thrombosis (DVT) also frequently occur in patients with AIHA [ 6 – 11 , 17 ]. Although PE has been reported as the most common cause of death in these patients [ 18 , 19 ] and has a lethal clinical course [ 20 , 21 ], limited numbers of Japanese patients with such clinical courses have been reported in recent literature [ 12 ]. In addition, systemic glucocorticoid administration is the first-line therapy of AIHA, but it has been reported to associate with thrombosis [ 22 , 23 ].…”