Haemolytic anaemia in previously healthy adult patients with CMV infections: Report of two cases and an evaluation of subclinical haemolysis in CMV mononucleosis

Abstract

Whereas haemolytic anaemia is commonly encountered in infants and young children with cytomegalovirus (CMV) infections, it is an infrequent complication of CMV‐induced infections in previously healthy adults. The data from 2 such patients are presented. One patient's Hb fell to a level of 36 g/l, and she required prednisone and blood transfusions. Her direct antihuman globulin test (DAT) was positive (IgG), and her red blood cell survival (51Cr) revealed a T1/2 of 5 d. Both saline‐agglutinating and low‐molecular‐weight cold agglutinins (CA) (4°C) that reacted against both cord and adult cells were identified. In the second case, a moderate haemolytic anaemia (lowest Hb 87 g/l) was accompanied by negative DAT and CA studies. 20 other patients with CMV‐mononucleosis were evaluated for evidence of subclinical haemolysis. Reticulocyte counts > 3.0% were noted in 9 of these patients. Haptoglobin values were below 0.5 g/l in 13 patients, and a positive DAT was recorded in 3/10 cases. This study documents haemolysis in many non‐immunosuppressed adult patients with CMV infections. The mechanism responsible remains obscure.

Hemolytic anemia due to acute cytomegalovirus infection in an immunocompetent adult: a case report and review of the literature

“…In patients with transplants, CMV is responsible for allograft rejection and opportunistic infection. Finally, CMV infection has been also associated with other manifestations, including hemolytic anemia [1-3]. …”

“…Severe hemolysis is a rare but potentially life-threatening complication of CMV infection described mostly in immunocompromised adults [1-3] and children [4]. The pathogenesis of hemolytic anemia during CMV infection is still unclear, although it has been hypothesized to be the result of immunologic activation [1-3].…”

“…The pathogenesis of hemolytic anemia during CMV infection is still unclear, although it has been hypothesized to be the result of immunologic activation [1-3]. Hemolytic anemia is rarely described in immunocompetent adults [1-3,5-8]. …”

An Infant with Acute Brucellosis Presenting With Coombs-Positive Autoimmune Hemolytic Anemia: Is Breastfeeding Guilty for Transmission?

“…Generally specific infectious agents, like M. pneumoniae, Epstein-Barr virus, varicella, mumps, measles, and rubella are associated with IgM autoantibodies (Rosenfield et al 1965). These antibodies have a specificity for the I/i polysaccharide antigen system on red blood cells, although reactivity with the P polysaccharide antigen has been reported (Horwitz et al 1984). Destruction of erythrocytes sensitized with IgM antibodies is mediated by the complement system.…”

Infectious Mononucleosis Complicated by Severe Immune Hemolysis

“…HIV infection can be complicated by hemolytic anemia, which can also occur in a few other diseases that may resemble infectious mononucleosis clinically. Infections with cytomegalovirus and lymphoproliferative disorders are among them (7,8,9).…”