{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:00:05Z","timestamp":1780394405503,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,10,11]],"date-time":"2017-10-11T00:00:00Z","timestamp":1507680000000},"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":[[2018,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Autoimmune hemolytic anemia (AIHA) due to anti\u2010En<jats:sup>a<\/jats:sup> has been previously reported in association with massive intravascular hemolysis, disseminated intravascular coagulation, and fatal outcomes. Here we report a case of successfully treated AIHA due to anti\u2010En<jats:sup>a<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec><jats:title>CASE REPORT<\/jats:title><jats:p>A 69\u2010year\u2010old male with a past medical history of cirrhosis due to nonalcoholic steatohepatitis status post\u2013orthotopic liver transplant presented with 1\u2010month history of progressive anemia. At presentation, his hemoglobin (Hb) was 5.6 g\/dL, hematocrit (Hct) 16%, reticulocytes 0.3%, direct bilirubin (bili) 4 g\/dL, lactate dehydrogenase 533 units\/L (reference, 125\u2010220 units\/L), and haptoglobin 254 mg\/dL (reference, 40\u2010273 mg\/dL). Blood bank testing revealed an autoantibody present in his plasma and a direct antiglobulin test positive for immunoglobulin G (IgC) but negative for complement. He received 1\u00a0unit of an incompatible blood group O phenotypically matched red blood cell unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Over the course of the next 5\u00a0days, the Hb and Hct decreased to 4.1 g\/dL and 12%, respectively, direct bili increased to 12.3 mg\/day, reticulocytes slightly increased to 0.9%, and haptoglobin decreased to less than 8 mg\/dL. Marrow study showed a hypercellular marrow with erythroid hyperplasia. Additional workup performed at a reference laboratory identified an anti\u2010En<jats:sup>a<\/jats:sup> autoantibody. He received prednisone and weekly rituximab infusions and was monitored weekly. At the 2\u2010month visit, Hb and Hct were 10\u00a0g\/dL and 32%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Unlike two of the previously reported fatal cases of AIHA with anti\u2010En<jats:sup>a<\/jats:sup> specificity, this 69\u2010year\u2010old male treated with weekly rituximab infusion underwent clinical recovery and significant anemia improvement.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.14363","type":"journal-article","created":{"date-parts":[[2017,10,12]],"date-time":"2017-10-12T04:20:39Z","timestamp":1507782039000},"page":"176-180","source":"Crossref","is-referenced-by-count":3,"title":["Acute autoimmune hemolytic anemia due to anti\u2010En<sup>a<\/sup> autoantibody successfully treated with rituximab"],"prefix":"10.1111","volume":"58","author":[{"given":"Elena","family":"Nedelcu","sequence":"first","affiliation":[{"name":"University of California San Francisco, Department of Laboratory Medicine San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Desai","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Green","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Department of Medicine, Division of Hematology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M.","family":"Bensing","sequence":"additional","affiliation":[{"name":"Immunohematology Reference Laboratory BloodCenter of Wisconsin Milwaukee Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Turner","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Head","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pampee P.","family":"Young","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Department of Pathology, Microbiology and Immunology Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"3036","DOI":"10.1182\/blood.V112.11.3036.3036","article-title":"Fatal disseminated intravascular coagulation and autoimmune hemolytic anemia due to anti\u2010Ena","volume":"112","author":"Klapper 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