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Warm autoimmune haemolytic anaemia seen in association with primary sclerosing cholangitis in the setting of Klebsiella pneumoniae bacteraemia
  1. Binoy Yohannan,
  2. Kok Hoe Chan,
  3. Arthi Sridhar and
  4. Modupe Idowu
  1. Division of Hematology and Oncology, Department of Internal Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
  1. Correspondence to Dr Arthi Sridhar; artshri{at}


Warm autoimmune haemolytic anaemia mediated by warm agglutinins is a rare and heterogeneous disease which can be idiopathic or secondary to an underlying disease. Primary sclerosing cholangitis is a chronic autoimmune cholangiopathy that is very rarely associated with haemolytic anaemia. Infections can also act as triggers for immune haemolytic anaemia. Here, we report a case of a woman in her 50s with a history of primary sclerosing cholangitis and a positive direct antiglobulin test with no evidence of haemolysis who developed overt warm autoimmune haemolytic anaemia in the setting of cholangitis and Klebsiella pneumoniae bacteraemia. She was treated conservatively with appropriate antibiotics and cautious red blood cell transfusion with complete resolution of haemolysis; immunosuppression was avoided given sepsis on presentation. This case highlights a rare association of warm immune haemolytic anaemia in the setting of K. pneumoniae bacteraemia and the role of a tailored treatment approach to treat this heterogeneous disease.

  • Liver disease
  • Haematology (incl blood transfusion)
  • Infectious diseases

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  • Contributors BY: Conception, design, data acquisition, literature review and drafting of manuscript. KHC: Collected images and revised the paper critically for important intellectual content. AS: Critically revised the manuscript for important intellectual content. MI: Contributed to the revision and final approval of the paper. All authors agree to be accountable for the accuracy of the work, and read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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