Various triggers for autoimmune hemolytic anemia in childhood

Autoimmune haemolytic anaemia (AIHA) is a diverse spectrum of disease entities that trigger the production and deposition of autoantibodies and/or a fixation of complement components on the target red blood cells (RBC). The final result is the intravascular and/or extravascular destruction of RBCs. Where immunological response is concerned there are three clinical entities of AIHA: with cold reacting, warm reacting or biphasic antibodies. Ethiologicaly, it is known that AIHA may occur in children after viral infection, immunization or it can be associated with immune connective tissue disease. In this report similar putative triggers linked with AIHA such as EBV, Mycoplasma pneumoniae, adeno virus infection, immunization and immune connective tissue disease are described in four children. All the cases described were treated with corticosteroides, three of them successfully, while one patient is still on therapy (three years period) due to persistent and severe AIHA coupled with putative autoimmune hepatitis. However, it seems that the prolonged course of disease in the three cases described here may be connected with HLA DR 2 and HLA B27.