AUTOIMMUNE HEMOLYTIC-ANEMIA AND POSITIVE COOMBS-TEST ASSOCIATED WITH ULCERATIVE-COLITIS

Objectives: To estimate the frequency of autoimmune hemolytic anemia a nd Coombs positivity without overt hemolysis in ulcerative colitis, to determine possible subsets of patients with ulcerative colitis suscep tible to this complication, and to assess the efficacy of the applied therapeutic modalities. Methods: Three hundred and two patients with u lcerative colitis treated at the University Hospital of Heraklion, Cre te, over a 6-yr period were included, Within this group, a subgroup of 152 patients were studied prospectively for the presence of a positiv e direct Coombs test, Results: Autoimmune hemolytic anemia was diagnos ed in five of 302 patients with ulcerative colitis (1.7%), One more pa tient developed Coombs-positive hemolytic anemia, attributed to sulfas alazine, A positive Coombs test without evidence of hemolysis was foun d in three of 152 patients (2%), The mean age of all Coombs-positive p atients was 50.5 Sr, and there was a definitive male preponderance (ma le: female, 2:1), Autoimmune hemolytic anemia occurred during active c olitis in all cases, The mean time between the onset of colitis and th e diagnosis of autoimmune hemolytic anemia was 17 months, Three of fiv e patients with autoimmune hemolytic anemia (60%) and seven of nine of all Coombs-positive patients (77.7%) had total colitis, All patients with autoimmune hemolytic anemia were treated initially with large dos es of corticosteroids. Three of five (60%) had good hematological resp onses, One patient responded to the addition of azathioprine, and one underwent splenectomy and proctocolectomy. Conclusions: In this study, the frequency with which autoimmune hemolytic anemia was associated w ith ulcerative colitis was higher than in previous reports, The compli cation occurred early in the course of colitis and was related to acti vity and extent of the disease, In contrast to others studies, we foun d a preponderance of males, Although corticosteroids and/or immunosupp ressive therapy was successful in most of our cases, one patient requi red surgery.