Cold agglutinin induced hemolytic anemia in a patient with pulmonary tuberculosis

Autoimmune hemolytic anemias (AIHA) are an uncommon group of disorders characterized by red cell destruction due to autoantibodies. Though usually idiopathic, AIHA is commonly associated with lymphoproliferative disorders, infections, autoimmune disease, and some drugs. This report describes a case of 25 year old female presenting history of fever associated with cough and fatigue. There was a past history of receiving blood transfusion on four occasions. The HRCT thorax demonstrated fine nodular densities in right upper lobe, suggestive of tuberculosis. Abdominal ultrasonography revealed mild splenomegaly. A bone marrow biopsy performed on the patient revealed erythroid hyperplasia. There was no evidence of any malignancy. Diagnosis of cold autoantibody hemolytic anemia complicated by pulmonary tuberculosis was made. The patient was managed with blood transfusions and treated with anti-tubercular agents. The occurrence of AIHA in pulmonary tuberculosis is rare.