Clinical Misdiagnosis of Autoimmune Hemolytic Anemia with Negative Re-sults for Coombs Test

XUE Xiang; HUANG Changbao; MENG Jiankang; NIE Shinan

doi:10.3969/j.issn.1002-3429.2024.08.002

Abstract：Objective To summarize the clinical characteristics,diagnosis and treatment,causes of misdiagnosis and preventive measures of autoimmune hemolytic anemia(AIHA)with negative results for Coombs test.Methods The clinical data of 11 patients with misdiagnosed AIHA with negative results for Coombs test admitted from June 2019 to September 2023 were retrospectively analyzed.Results Six patients presented with black stool and were misdiagnosed as acute upper gastroin-testinal bleeding.Two patients presented with abdominal pain and jaundice,abdominal CT showed choledocholithiasis,and they were misdiagnosed as choledocholithiasis with acute cholangitis.Three patients presented with syncope;folate and vitamin B12 were decreased,and the blood routine showed macrocytic anemia;therefore,they were misdiagnosed with megaloblastic anemia.The duration of misdiagnosis was(4.82±1.67)d.All 11 patients were tested negative for Coombs test,6 patients were diagnosed after diagnostic therapy and comprehensive evaluation,2 patients were confirmed by positive results for Coombs test of bone marrow mononuclear cell,and 3 patients were referred to other hospitals and diagnosed as Coombs test negative AIHA for positive results of autoantibodies by microcolumn gel method.All 11 patients received corresponding treatment,of whom 9 patients had a favorable prognosis,1 patient died,and 1 patient gave up treatment and was discharged.Conclusion Coombs test negative AIHA is rare in clinical practice and lack of specific symptoms and signs,which is,therefore,more likely to be misdiagnosed.To strengthen clinicians'awareness of this disease and enhance their vigilance.For those who are highly suspected of AIHA but have a negative results for Coombs test,diagnostic treatment can be given after comprehensive evaluation.If necessary,Coombs test of bone marrow cells for screening or referral to a higher-level hospital can be provided.