{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:48:18Z","timestamp":1781632098521,"version":"3.54.5"},"reference-count":10,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,9,11]],"date-time":"2014-09-11T00:00:00Z","timestamp":1410393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2015,3]]},"abstract":"Background<\/jats:title>E<\/jats:styled-content>vans syndrome is a rare condition manifested by combined autoimmune hemolytic anemia (AIHA<\/jats:styled-content>) and thrombocytopenia or neutropenia. It is often associated with other autoimmune disorders, immunodeficiencies, and non\u2010H<\/jats:styled-content>odgkin's lymphoma.<\/jats:p><\/jats:sec>Case Report<\/jats:title>We describe a patient with E<\/jats:styled-content>vans syndrome that may have been related to exposure to a polyethylene\u2010based intrauterine contraceptive device (IUD<\/jats:styled-content>). A 26\u2010year\u2010old white female presented with severe, symptomatic AIHA<\/jats:styled-content> and subsequently developed severe thrombocytopenia. She had a refractory course resistant to multiple treatments including corticosteroids, intravenous immune globulin, rituximab, splenectomy, cyclophosphamide, cyclosporine, eculizumab, and plasma exchange. It was then noticed that her serum autoantibody agglutinated red blood cells (RBCs<\/jats:styled-content>) in the presence of polyethylene glycol (PEG<\/jats:styled-content>) but not in the absence of PEG<\/jats:styled-content> nor when an alternative agglutination enhancing technique, low\u2010ionic\u2010strength solution, was used. Therefore, her polyethylene\u2010containing IUD<\/jats:styled-content>, which was a polyethylene frame with a levonorgestrel\u2010releasing device, was removed. Norgestrel\u2010dependent, platelet (PLT<\/jats:styled-content>)\u2010reactive antibodies were not identified by either flow cytometry or in vivo in a NOD<\/jats:styled-content>\/SCID<\/jats:styled-content> mouse. Testing for PEG<\/jats:styled-content>\u2010dependent antibodies was not possible. Remission, with no requirement for RBC<\/jats:styled-content> or PLT<\/jats:styled-content> transfusions and return of her hemoglobin and PLT<\/jats:styled-content> counts to normal, followed removal of the IUD<\/jats:styled-content>.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The patient's recovery after removal of the IUD<\/jats:styled-content> and the PEG<\/jats:styled-content> dependence of RBC<\/jats:styled-content> agglutination suggested a possibility that the IUD<\/jats:styled-content> may have been a contributing factor to the etiology of E<\/jats:styled-content>vans syndrome in this patient.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.12865","type":"journal-article","created":{"date-parts":[[2014,9,11]],"date-time":"2014-09-11T08:54:24Z","timestamp":1410425664000},"page":"657-660","source":"Crossref","is-referenced-by-count":3,"title":["Autoimmune hemolytic anemia and thrombocytopenia attributed to an intrauterine contraceptive device"],"prefix":"10.1111","volume":"55","author":[{"given":"Mohamad O.","family":"Khawandanah","sequence":"first","affiliation":[{"name":"Hematology\u2010Oncology Section Department of Medicine The University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad A.","family":"Cherry","sequence":"additional","affiliation":[{"name":"Hematology\u2010Oncology Section Department of Medicine The University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Maymani","sequence":"additional","affiliation":[{"name":"Department of Medicine The University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George B.","family":"Selby","sequence":"additional","affiliation":[{"name":"Hematology\u2010Oncology Section Department of Medicine The University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard H.","family":"Aster","sequence":"additional","affiliation":[{"name":"Blood Center of Wisconsin and Medical College of Wisconsin Milwaukee Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James N.","family":"George","sequence":"additional","affiliation":[{"name":"Hematology\u2010Oncology Section Department of Medicine The University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Holter Chakrabarty","sequence":"additional","affiliation":[{"name":"Hematology\u2010Oncology Section Department of Medicine The University of Oklahoma Health Sciences Center Oklahoma City Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,9,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-04-215368"},{"key":"e_1_2_7_3_1","first-page":"437","volume-title":"Technical manuel","author":"Downes KA","year":"2011"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V84.1.176.176"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-03-277764"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2013.05.005"},{"issue":"8100","key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/S0140-6736(78)92327-9","article-title":"Paracetamol\u2010induced thrombocytopenia and haemolytic anaemia","volume":"2","author":"Kornberg 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