A 21 year old male presents with anemia and mild hepatosplenomegaly. His hemoglobin is 5 gni/dL history of single blood transfusion is present till date. Most probable diagnosis is :
Autoimmune hemolytic anemia > Thalassemia intermedia It is a close diagnosis between autoimmune hemolytic anemia and thalassemia intermedia. 1 am more in our of autoimmune hemolytic anemia. Factors which our Autoimmune hemolytic anemia Age and sex of the patient - AIHA is mare common in adult females Severity of anemia - In many cases of AMA, anemia is severe with Hb < 6 ing/d1. Factors which goes against Autoimmune hemolytic anemia Adequate response with blood transfusion only - Patients with AIHA are managed by glucocoicoid therapy not by blood transfusion. - Severe anemia in AIHA requires immediate blood transfusion but the patient will not remain asymptomatic in the absence of glucocoicoid therapy, other immunosuppressant or splenectomy is definitely needed to kees the patient asymptomatic. So adequate response to blood transfusion without any other therapy strongly ours thalassemia intermediate. Features which goes against thalassemia intermediate Severe anemia (1-lb < 5) - Patients with thalassemia intermedia presents with moderate degree of anemia (10g/dl) - Even in severe cases of thalassemia the Hb level rarely go below 7g/d1. More on t/t of Autoimmune hemolytic anemia Autoimmune hemolytic anemia .Mild . Watch . Moderate --> . Begin with glucocoicoids . If no response, splenectomy / iinmunosuppresants .Severe ---> . Either glucocoicoid or splenectomy
Thalassemia major
Thalassemia minor
Thalassemia intermedia
Autoimmune hemolytic anemia