Autoimmune hemolytic anemia and thrombocytopenia attributed to an intrauterine contraceptive device

• DOI: 10.1111/trf.12865
• Publication Date: 2014-09-11T08:54:24Z
• Authors: Mohamad O. Khawan...; Susan M. Weiss; Mohamad A. Cherry; Hossein Maymani; George B. Selby; Richard H. Aster; James N. George; Jennifer L. Holte...
• Keywords: Autoimmune thrombocytopenia

Background E vans syndrome is a rare condition manifested by combined autoimmune hemolytic anemia ( AIHA ) and thrombocytopenia or neutropenia. It often associated with other disorders, immunodeficiencies, non‐ H odgkin's lymphoma. Case Report We describe patient that may have been related to exposure polyethylene‐based intrauterine contraceptive device IUD ). A 26‐year‐old white female presented severe, symptomatic subsequently developed severe thrombocytopenia. She had refractory course resistant multiple treatments including corticosteroids, intravenous immune globulin, rituximab, splenectomy, cyclophosphamide, cyclosporine, eculizumab, plasma exchange. was then noticed her serum autoantibody agglutinated red blood cells RBCs in the presence of polyethylene glycol PEG but not absence nor when an alternative agglutination enhancing technique, low‐ionic‐strength solution, used. Therefore, polyethylene‐containing , which frame levonorgestrel‐releasing device, removed. Norgestrel‐dependent, platelet PLT )‐reactive antibodies were identified either flow cytometry vivo NOD / SCID mouse. Testing for ‐dependent possible. Remission, no requirement RBC transfusions return hemoglobin counts normal, followed removal . Conclusion The patient's recovery after dependence suggested possibility contributing factor etiology this patient.