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Taipei City Hospital


Autoimmune Hemolytic Anemia can lead to heart palpitations and shortness of breath

       Mr. Liu is 92 years old, has normal blood pressure, a normal diet and no history of diabetes. At first he felt slight dizziness and fatigue, but in recent months he began to experience increased palpitations, shortness of breath during walking and increased fatigue, which made him unable to walk normally and thus brought him to the hospital.

       Hematological examination has revealed severe anemia, his hemoglobin level at only 6.5g/dL (gram/100 ml); his reticulocyte count was high, and both white blood cell and platelet counts were normal. The subject was hospitalized for treatment and further examinations. Pathological tests have revealed jaundice in the sclera, pale conjunctiva, no enlargement of liver and spleen and normal lymph nodes. An abdominal CT scan showed normal results and no presence of tumors; both direct and indirect Coombs’ tests were positive; monoclonal antibody of anti-C3d was positive and anti-IgG was negative; antibodies from washed red blood cells were anti-IGM and anti-kappa; immunofixation electrophoresis showed the monoclonal antibody IGM-kappa.

       “These are the results of the asexual reproduction of B cells,” said Dr. Zhi Yu Li, Director of the Division of Hematology & Oncology at the Zhongxiao Branch of the Taipei City Hospital. These cells secrete monoclonal antibodies of the IGM-kappa type, which causes hemolysis of red blood cells. Bone marrow aspiration biopsy showed a mild increase of atypical lymphocyte proliferation by about 10%; immunostaining was positive for anti-CD20. The patient was ultimately diagnosed with autoimmune hemolytic anemia.

       What is autoimmune hemolytic anemia? Dr. Li explained that it is a condition where the body produces abnormal antibodies that targets the body’s own red blood cells, which causes antigen-antibody reactions that break down red blood cells at the spleen, leading to anemia and jaundice. The normal hemoglobin level in males is 14-18 g/dL, and 12-14 g/dL for females. Any level lower than these usually indicate the presence of anemia; hemoglobin level lower than 8 g/dL will cause dizziness, palpitations, shortness of breath when walking and fatigue.