Warm Autoimmune Hemolytic Anemia in a Newly Diagnosed Patient With HIV: A Rare Hematological Complication

Swati Saini; Anushka Garg; Aryan Deol; Sheetal Panjariya; Darab Singh

doi:10.36948/ijfmr.2026.v08i04.85095

Warm Autoimmune Hemolytic Anemia in a Newly Diagnosed Patient With HIV: A Rare Hematological Complication

Author(s)	Dr. Swati Saini, Dr. Anushka Garg, Dr. Aryan Deol, Dr. Sheetal Panjariya, Dr. Darab Singh
Country	India
Abstract	Introduction: Autoimmune hemolytic anemia (AIHA) represents a relatively rare but important hematological complication among individuals infected with human immunodeficiency virus (HIV). Although anemia is the commonest hematological abnormality in this population, the immune-mediated causes, such as warm AIHA, tend to be overlooked. HIV-related immune dysregulation, polyclonal B cell activation, and immune reconstitution in response to antiretroviral therapy have all been implicated in the pathogenesis of AIHA. Case Presentation: Here we describe a case of warm AIHA in a 36-year-old male with newly diagnosed HIV who developed this condition two months following initiation of tenofovir, lamivudine, and dolutegravir (TLD) combination therapy for his HIV infection. The patient had presentation of altered mental status, cognitive dysfunction, and severe anemia (hemoglobin level 3.6 g/dL) with macrocytosis (MCV 145 fL), profound reticulocytosis (43.1%), indirect hyperbilirubinemia, and elevated lactate dehydrogenase (2704 U/L). The peripheral blood film showed spherocytes, nucleated red blood cells, and polychromasia. The direct antiglobulin test was strongly positive (4+) for IgG and C3d, confirming warm AIHA. In addition, cerebrospinal fluid analysis and contrast MRI brain confirmed the diagnosis of Progressive Multifocal Leukoencephalopathy (PML) caused by infection with the JC virus. The management included blood transfusion, intravenous methylprednisolone (500 mg daily for three days) followed by high-dose oral prednisolone (60 mg/day), along with continuation of antiretroviral therapy. At discharge, hemoglobin had improved to 7.4 g/dL with clinical stabilization. Conclusion: In this particular case, we learn about the need for a consideration of AIHA being one of the causes of severe anemia in newly diagnosed patients with HIV, especially in those who have been initiated on ART. Prompt treatment with corticosteroids along with continued ART is necessary to achieve good results. The occurrence of PML in this patient makes the situation even more complex.
Keywords	Autoimmune hemolytic anemia, Progressive Multifocal Leukoencephalopathy
Field	Biology
Published In	Volume 8, Issue 4, July-August 2026
Published On	2026-08-03
DOI	https://doi.org/10.36948/ijfmr.2026.v08i04.85095

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Warm Autoimmune Hemolytic Anemia in a Newly Diagnosed Patient With HIV: A Rare Hematological Complication

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