Infantile cytomegalovirus-associated autoimmune hemolytic anemia

Autoimmune hemolytic anemia (AIHA) is a hematologic disorder that is rarely seen in infants and young children. Most cases are associated with viral o r bacterial infection, but the immunologic events leading to hemolysis are poorly understood. We describe two infants with severe cytomegalovirus (CMV )associated warm antibody AIHA. One case was immunohematologically analyzed and showed suggestive evidence that endogenous anti-CMV IgG antibodies wer e the pathogenic antibodies leading to hemolysis, implicating a possible ca usal relationship between AIHA and CMV infection. Both patients were ultima tely treated with intravenous CMV immune globulin, with subsequent improvem ent. These cases suggest that investigation for the presence of CMV in infa ntile AIHA is warranted and that CMV immune globulin should be considered a s a therapeutic option.