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首页> 外文期刊>European journal of gastroenterology and hepatology >Coombs-positive autoimmune hemolytic anemia in Crohn's disease.
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Coombs-positive autoimmune hemolytic anemia in Crohn's disease.

机译：克罗恩病中库恩斯阳性的自身免疫性溶血性贫血。

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BACKGROUND: Anemia often occurs in patients with inflammatory bowel diseases. However, hemolytic anemia is a rare complication and is associated with Coombs-positive autoimmune disorders. There are several reports of autoimmune hemolytic anemia in patients with ulcerative colitis, whereas there are only four reports of this complication in patients with Crohn's disease. We report a case of a severe course Coombs-positive hemolytic anemia in a patient with Crohn's disease, which was refractory to medical treatment but resolved after subtotal colectomy. CASE REPORT: A 29-year-old patient was submitted to our clinic several times because of a severe course of inflammatory bowel disease and additionally a Coombs-positive autoimmune hemolytic anemia. Histology indicated severe Crohn's disease, but neither medical treatment with steroids, nor with methotrexate, cyclosporine or tumor necrosis factor-alpha antibody had been successful in resolving the intestinal inflammation and the hemolytic anemia. As colonoscopy revealed a pancolitis and dysplastic changes, even in the less inflamed areas of the colonic mucosa, subtotal colectomy was indicated. Half a year later we observed clinical and immunological signs of complete remission (no gastrointestinal symptoms, negative Coombs test). CONCLUSION: Autoimmune hemolytic anemia is a rare complication of inflammatory bowel disease and has been almost exclusively described in ulcerative colitis. The etiology is not yet completely understood. Presumably, the colon displays a role in the production of anti-erythrocyte antibodies. The therapy of choice in Crohn's associated hemolytic anemia is thought to be medical treatment with corticoid steroids. Some authors additionally prefer immunmodulators. However, in the case presented, colectomy (without splenectomy) was necessary to resolve refractory hemolysis and the severe course of Crohn's disease.
机译：背景：贫血常发生在炎症性肠病患者中。但是，溶血性贫血是一种罕见的并发症，与库姆斯阳性的自身免疫性疾病有关。溃疡性结肠炎患者中有几种自身免疫性溶血性贫血的报道，而克罗恩病患者中只有4例报道这种并发症。我们报告了一名克罗恩病患者的严重病程库姆斯阳性溶血性贫血，该病对药物治疗无效，但在结肠次全切除术后得以解决。病例报告：一名29岁的患者因炎症性肠病的严重病程以及库姆斯阳性的自身免疫性溶血性贫血而多次被送往我们的诊所。组织学表明严重的克罗恩氏病，但是用类固醇，甲氨蝶呤，环孢素或肿瘤坏死因子-α抗体的药物治疗均未成功解决肠道炎症和溶血性贫血。由于结肠镜检查显示出全结肠炎和增生异常改变，即使在结肠粘膜的炎症程度较低的区域，也显示了大肠切除术。半年后，我们观察到完全缓解的临床和免疫学体征（无胃肠道症状，库姆斯试验阴性）。结论：自身免疫性溶血性贫血是炎症性肠病的一种罕见并发症，在溃疡性结肠炎中几乎完全被描述。病因尚未完全了解。据推测，结肠在抗红细胞抗体的产生中发挥作用。克罗恩病相关的溶血性贫血的治疗选择被认为是皮质类固醇激素的药物治疗。一些作者还更喜欢免疫调节剂。然而，在本例中，结肠切除术（不行脾切除术）对于解决难治性溶血和克罗恩病的严重病情是必要的。

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