Thyroid storm and warm autoimmune hemolytic anemia

Joseph A. Moore, Louise Gliga, Srikanth Nagalla

Research output: Contribution to journalArticle

Abstract

Graves’ disease is often associated with other autoimmune disorders, including rare associations with autoimmune hemolytic anemia (AIHA). We describe a unique presentation of thyroid storm and warm AIHA diagnosed concurrently in a young female with hyperthyroidism. The patient presented with nausea, vomiting, diarrhea and altered mental status. Laboratory studies revealed hemoglobin 3.9 g/dL, platelets 171 × 109 L−1, haptoglobin <5 mg/dL, reticulocytosis, and positive direct antiglobulin test (IgG, C3d, warm). Additional workup revealed serum thyroid stimulating hormone (TSH) <0.01 μIU/mL and serum free-T4 (FT4) level 7.8 ng/dL. Our patient was diagnosed with concurrent thyroid storm and warm AIHA. She was started on glucocorticoids to treat both warm AIHA and thyroid storm, as well as antithyroid medications, propranolol and folic acid. Due to profound anemia and hemodynamic instability, the patient was transfused two units of uncrossmatched packed red blood cells slowly and tolerated this well. She was discharged on methimazole as well as a prolonged prednisone taper, and achieved complete resolution of the thyrotoxicosis and anemia at one month. Hyperthyroidism can affect all three blood cell lineages of the hematopoietic system. Anemia can be seen in 10–20% of patients with thyrotoxicosis. Several autoimmune processes can lead to anemia in Graves’ disease, including pernicious anemia, celiac disease, and warm AIHA. This case illustrates a rarely described presentation of a patient with Graves’ disease presenting with concurrent thyroid storm and warm AIHA.

Original languageEnglish (US)
Pages (from-to)606-608
Number of pages3
JournalTransfusion and Apheresis Science
Volume56
Issue number4
DOIs
StatePublished - Aug 1 2017

Fingerprint

Thyroid Crisis
Autoimmune Hemolytic Anemia
Anemia
Graves Disease
Thyrotoxicosis
Hyperthyroidism
Reticulocytosis
Methimazole
Coombs Test
Hematopoietic System
Pernicious Anemia
Haptoglobins
Celiac Disease
Cell Lineage
Thyrotropin
Prednisone
Serum
Folic Acid
Propranolol
Nausea

Keywords

  • Graves disease
  • Thyroid storm
  • Thyrotoxicosis
  • Warm autoimmune hemolytic anemia

ASJC Scopus subject areas

  • Hematology

Cite this

Thyroid storm and warm autoimmune hemolytic anemia. / Moore, Joseph A.; Gliga, Louise; Nagalla, Srikanth.

In: Transfusion and Apheresis Science, Vol. 56, No. 4, 01.08.2017, p. 606-608.

Research output: Contribution to journalArticle

Moore, Joseph A. ; Gliga, Louise ; Nagalla, Srikanth. / Thyroid storm and warm autoimmune hemolytic anemia. In: Transfusion and Apheresis Science. 2017 ; Vol. 56, No. 4. pp. 606-608.
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