Severe Autoimmune Haemolytic anaemia with ABO Mismatch and Transfusion Incompatibility indicating Underlying Leukemia in an older woman

Namrita Yadav

doi:10.36948/ijfmr.2026.v08i01.66647

Severe Autoimmune Haemolytic anaemia with ABO Mismatch and Transfusion Incompatibility indicating Underlying Leukemia in an older woman

Author(s)	Ms. Namrita Yadav
Country	India
Abstract	Severe anemia in older adults might be the initial clinical sign of an underlying immune or blood disorder and demands thorough laboratory assessment. This case study describes a 72-year-old female who arrived with severe anemia, evidenced by a hemoglobin level of 4.3 g/dL and a significantly low red blood cell count of 1.8 million/µL. Routine blood grouping via the slide method revealed AB positive, while confirmatory testing through the tube method classified the blood group as A positive, highlighting a notable ABO discrepancy. These inconsistencies sparked concerns regarding immune-mediated red cell agglutination.Compatibility testing demonstrated pan-reactive cross-match incompatibility with all donor units, and the incompatibility continued even at 37 °C, indicating the existence of warm-reactive antibodies. Additional immunohematological assessments revealed a positive autoimmune screening and both direct and indirect Coombs tests, validating the existence of IgG autoantibodies attached to red blood cells and present in the patient’s serum. These results confirmed a diagnosis of warm autoimmune hemolytic anemia (AIHA). Given the patient's older age and the possibility of an alternate cause, additional hematological testing was conducted. Subsequent examinations uncovered signs of an underlying leukemic condition, which is a recognized cause of secondary warm AIHA resulting from immune dysregulation and unusual autoantibody production. This case underscores the diagnostic challenges of autoimmune hemolytic anemia in older individuals and points out the necessity of addressing ABO discrepancies and transfusion incompatibility via comprehensive immuno hematological testing. Timely detection of secondary factors like leukemia is crucial, since treatment relies on managing hemolysis as well as addressing the primary cancer. Prompt diagnosis and suitable treatment can greatly decrease illness and enhance overall patient results
Keywords	consider underlying leukemia.Autoantibodies lead to ABO incompatibility and transfusion reactions. Positive direct Coombs test. Difficult cross-matching used, least incompatible blood. Lymphocytosis and splenomegaly indicate leukemia.
Field	Medical / Pharmacy
Published In	Volume 8, Issue 1, January-February 2026
Published On	2026-01-17
DOI	https://doi.org/10.36948/ijfmr.2026.v08i01.66647

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Severe Autoimmune Haemolytic anaemia with ABO Mismatch and Transfusion Incompatibility indicating Underlying Leukemia in an older woman

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