AUTOIMMUNE HEMOLYTIC-ANEMIA, PRIMARY ADRENAL INSUFFICIENCY, AND THE ANTIPHOSPHOLIPID SYNDROME

Autoimmune hemolytic anemia and adrenal insufficiency are rarely assoc iated with the antiphospholipid antibody syndrome. A 49-year-old woman with a history of deep venous thrombosis and recurrent miscarriages w as found to have active autoimmune hemolytic anemia after being admitt ed to the hospital for cholelithiasis. The patient was treated with co rticosteroids and underwent laparoscopic cholecystectomy 1 month later . Two weeks after surgery she had acute adrenal insufficiency, Activat ed partial thromboplastin time was prolonged, and antiphospholipid ant ibodies were detected in significant titer. Her illness responded well to corticosteroid therapy. Her direct Coombs' test remained positive, It appears that the antiphospholipid antibody syndrome contributed to the development of venous thrombosis, recurrent miscarriages, autoimm une hemolytic anemia, adrenal insufficiency, and indirectly, pigment s tone cholelithiasis in this patient.