{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T12:07:16Z","timestamp":1763726836842},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,10,29]],"date-time":"2014-10-29T00:00:00Z","timestamp":1414540800000},"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":"<jats:sec><jats:title>Background<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>vans syndrome (<jats:styled-content style=\"fixed-case\">ES<\/jats:styled-content>) is characterized by the simultaneous or sequential presence of multiple autoimmune cytopenias. It is often secondary to rheumatologic disorders or lymphoid malignancies, but has not previously been associated with babesiosis. Here we present two cases of severe cytopenias in asplenic patients precipitated by active babesiosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>The first patient had a history of <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>odgkin's lymphoma in remission and autoimmune hemolytic anemia (<jats:styled-content style=\"fixed-case\">AIHA<\/jats:styled-content>) treated by splenectomy 12 years prior who presented with severe <jats:styled-content style=\"fixed-case\">AIHA<\/jats:styled-content> and thrombocytopenia after <jats:italic><jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>abesia<\/jats:italic> infection. The second patient had a history of <jats:styled-content style=\"fixed-case\">ES<\/jats:styled-content> requiring splenectomy, which relapsed after <jats:italic><jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>abesia<\/jats:italic> infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The complex presentation and medical histories of both patients made the diagnosis challenging. Both patients\u2019 cytopenias responded to therapy, although the use of immunosuppressive agents in patients with active hematologic infections was challenging and required a multidisciplinary approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These two cases illustrate the possibility of babesiosis to not only reactivate <jats:styled-content style=\"fixed-case\">ES<\/jats:styled-content> in asplenic patients, but also precipitate increased levels of immune deregulation, potentially provoking <jats:styled-content style=\"fixed-case\">ES<\/jats:styled-content>, a phenomenon not previously reported.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.12901","type":"journal-article","created":{"date-parts":[[2014,10,30]],"date-time":"2014-10-30T03:54:39Z","timestamp":1414641279000},"page":"661-665","source":"Crossref","is-referenced-by-count":10,"title":["Profound autoimmune hemolysis and <scp>E<\/scp>vans syndrome in two asplenic patients with babesiosis"],"prefix":"10.1111","volume":"55","author":[{"given":"Joseph J.","family":"Shatzel","sequence":"first","affiliation":[{"name":"Department of Medicine Dartmouth Hitchcock Medical Center  Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelsey","family":"Donohoe","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology Lenox Hill Hospital  New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngoc\u2010Quynh","family":"Chu","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth  Hanover New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Garratty","sequence":"additional","affiliation":[{"name":"American Red Cross Blood Services  Pomona California"},{"name":"Department of Pathology and Laboratory Medicine University of California  Los Angeles California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kabir","family":"Mody","sequence":"additional","affiliation":[{"name":"Department of Medicine Dartmouth Hitchcock Medical Center  Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth M.","family":"Bengtson","sequence":"additional","affiliation":[{"name":"Department of Medicine Dartmouth Hitchcock Medical Center  Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy M.","family":"Dunbar","sequence":"additional","affiliation":[{"name":"Department of Medicine Dartmouth Hitchcock Medical Center  Lebanon New Hampshire"},{"name":"Department of Pathology Dartmouth Hitchcock Medical Center  Lebanon New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,10,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2008.03.010"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20262"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(87)80552-8"},{"key":"e_1_2_6_5_1","unstructured":"1995 E Beutler E Beutler MA Lichtman BS Coller TJ Kipps Hemolytic anemia due to infections with microorganisms 674 676"},{"key":"e_1_2_6_6_1","unstructured":"1969 B Pirofsky Autoimmunization and the autoimmune hemolytic anemias 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