Autoimmune Hemolytic Anemia associated with Ulcerative Colitis

Review Article


Autoimmune Hemolytic Anemia Associated with Ulcerative Colitis

Eduardo Leo, Claudio Trigo, José M Herrera and José L Márquez

Affiliations: ¹Department of Gastroenterology, University Hospital Virgen del Rocío


ABSTRACT

Although anemia is very common in patients with ulcerative colitis, its association with autoimmune hemolytic anemia is infrequent. This is a review of the cases reported to date, with an analysis of the underlying physiopathological mechanisms. In this context, it is suggested that the inflammatory alterations at colon level act as an antigenic stimulant, resulting in the formation of antibodies exhibiting cross‐reactivity with the erythrocytes, although other theories have also been proposed. Drugs destined to modulate the immune system are the treatment of choice when both conditions coexist, involving a step‐up regimen starting with steroids. For years, surgery has been advocated as rescue treatment in the case of steroid failure, although the introduction of new immunosuppressor drugs and biological agents now offers new alternatives.

Keywords: ulcerative colitis, autoimmune hemolytic anemia, Coombs’ test

Correspondence: Eduardo Leo, Department of Gastroenterology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n. 41013, Seville, Spain. Tel: (34)‐955‐01‐22‐51; e‐mail: eleoc@telefonica.net