{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T08:39:16Z","timestamp":1707381556314},"reference-count":22,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,10,6]],"date-time":"2018-10-06T00:00:00Z","timestamp":1538784000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Evans syndrome is a rare autoimmune disorder that is defined by the simultaneous or sequential presence of two or more cytopenias without an obvious underlying precipitating cause. Evans syndrome usually follows a chronic relapsing and remitting course and is quite rare, making it difficult to evaluate in clinical studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>CASE REPORT<\/jats:title><jats:p>A 66\u2010year\u2010old male patient with a 17\u2010year history of Evans syndrome presented with fulminant autoimmune hemolytic anemia (AIHA). He presented with a markedly elevated C\u2010reactive protein (CRP; 46 mg\/L [normal, 0\u20105 mg\/L]) before onset of a decrease in hemoglobin. He required the transfusion of 20 units of red blood cells while awaiting response to aggressive immunosuppressive therapy including high\u2010dose corticosteroids, intravenous immunoglobin therapy, and rituximab. He achieved a complete hematologic response.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>His postdischarge course was complicated by acute cholecystitis requiring laparoscopic cholecystectomy. In addition, his transfusional iron overload requiring 16 phlebotomies to reduce his ferritin level from 4933 \u03bcg\/L to 326 \u03bcg\/L, with phlebotomies ongoing every 2 weeks to achieve a ferritin level of less than 100 \u03bcg\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Neither transfusional iron overload nor acute cholecystitis are well\u2010recognized complications of a severe episode of AIHA. An elevated CRP has been recently recognized as an important prognostic marker in patients with immune thrombocytopenic purpura and this case suggests a need to evaluate its utility in AIHA.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.14888","type":"journal-article","created":{"date-parts":[[2018,10,6]],"date-time":"2018-10-06T14:58:25Z","timestamp":1538837905000},"page":"2777-2781","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Complications of a severe autoimmune hemolytic anemia crisis: transfusional iron overload and gangrenous cholecystitis"],"prefix":"10.1111","volume":"58","author":[{"given":"Isabella","family":"Menchetti","sequence":"first","affiliation":[{"name":"School of Medicine University of St Andrews, St Andrews  Scotland UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yulia","family":"Lin","sequence":"additional","affiliation":[{"name":"Laboratory Medicine and Pathobiology 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