Work

Comprehensive management of immune-related hemolytic anemia in a patient with acute cholangitis: A case report

Year: 2025

Type: article

Abstract: ABSTRACTRATIONALE: Immune-associated hemolytic anemia is an uncommon and potentially life-threatening complication in patients with choledocholithiasis and acute cholangitis. Its occurrence during the perioperative period remains rarely reported. PATIENT CONCERNS: A 69-year-old woman presented with right upper abdominal pain and was diagnosed with choledocholithiasis and acute cholangitis. During hospitalization, she developed sudden confusion and shock, with her hemoglobin rapidly declining to 26 g/L. DIAGNOSES: The patient was diagnosed with acute cholangitis and immune-related hemolytic anemia based on clinical manifestations and a positive direct antihuman globulin (Coombs) test. INTERVENTIONS: The patient received high-dose glucocorticoid therapy combined with red blood cell transfusion, followed by endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and nasobiliary drainage to relieve biliary obstruction, and subsequent laparoscopic cholecystectomy. OUTCOMES: After timely diagnosis and comprehensive management, the patient's hemoglobin stabilized, hemolysis resolved, and she recovered without postoperative complications. LESSONS: This case provides 3 important lessons for clinical practice: The need for prompt recognition and management of unexpected perioperative complications and flexible adjustment of clinical thinking. A systematic approach for handling sudden and life-threatening hemoglobin decline. Appropriate timing and optimal surgical strategy selection for delayed definitive surgery after stabilization.

Source: Medicine

DOI: 10.1097/md.0000000000045892

Authors: Jun Chen, Xian-Feng Wang, Jin Yu, Sheng Xu, Feng Zheng, Zhong-Kai Ni

Institution: Hangzhou Hospital of Traditional Chinese Medicine

Language: English

Topic: Gallbladder and Bile Duct Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,950