Immune-Mediated Coombs Negative Intravascular Hemolysis in Systemic Lupus Erythematosus

August 2021 in “ BMJ Case Reports ”

Bhoobalan Magendiran, Prasan Kumar Panda, Kolar Vishwanath Vinod, Chanaveerappa Bammigatti

TLDR A woman with lupus had blood cell destruction, treated successfully with medication.

The document discussed a rare case of immune-mediated Coombs negative intravascular hemolysis in a 27-year-old woman with systemic lupus erythematosus (SLE). Despite presenting with symptoms of hemolysis, standard Coombs tests were negative. The patient exhibited excessive hair loss, weight loss, amenorrhea, fever, and abdominal pain, with lab results showing a drop in hemoglobin, indirect hyperbilirubinemia, raised LDH, and hemoglobinuria. Positive antinuclear and anti-dsDNA antibodies confirmed SLE. Treatment with prednisolone and hydroxychloroquine resolved the hemolysis, with no further episodes during follow-up. The case underscored the need for alternative diagnostic approaches and heightened clinical awareness in managing atypical SLE presentations.

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