Research Article: Tuberculosis induced autoimmune haemolytic anaemia: a systematic review to find out common clinical presentations, investigation findings and the treatment options

Date Published: March 26, 2018

Publisher: BioMed Central

Author(s): Devarajan Rathish, Sisira Siribaddana.


Tuberculosis induced autoimmune haemolytic anaemia is a rare entity. The aim of this study was to explore its common presentations, investigation findings and treatment options through a systematic review of published reports.

PubMed, Trip, Google Scholar, Science Direct, Cochrane Library, Open-Grey, Grey literature report and the reference lists of the selected articles were searched for case reports in English on tuberculosis induced auto-immune haemolytic anaemia. PRISMA statement was used for systematic review. Quality assessment of the selected reports was done using the CARE guidelines.

Twenty-one articles out of 135 search results were included. Thirty-three percent of patients were reported from India. More than half had fever and pallor. The mean haemoglobin was 5.77 g/dl (SD 2.2). Positive direct coombs test was seen in all patients. Pulmonary tuberculosis (43%) was most prevalent. Twenty-nine percent of patients needed a combination of anti-tuberculosis medicines, blood transfusion and steroids. Higher percentage of disseminated TB induced AIHA (67%) needed steroids in comparison to the other types of TB induced AIHA (13%).

Rarer complications of tuberculosis such as auto-immune haemolytic anaemia should be looked for especially in disease-endemic areas. Blood transfusion and steroids are additional treatment options along with the anti-tuberculosis medicines.

The online version of this article (10.1186/s13223-018-0236-y) contains supplementary material, which is available to authorized users.

Partial Text

Tuberculosis (TB) infection is caused by Mycobacterium tuberculosis. Pathogenesis of TB includes primary, latent and reactivation TB [1]. Pulmonary TB is the most frequent type [2], however, it can affect almost all the human organs. Immuno-compromised individuals are more susceptible. Globally TB is among the most common causes of mortality. The majority of the deaths occur in developing countries and India tops the list. Asia and Africa recorded 61% and 26% of new TB cases respectively in 2015 [2].

The review was conducted based on the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement [9].

Anaemia alone or in combination with other blood abnormalities was seen in 63% of miliary TB patients [44]. Proposed mechanisms were nutritional deficiencies, malabsorption due to GIT tuberculosis, associated anorexia and immune mediated marrow suppression [7]. TB induced AIHA is a rare entity in a patient with anaemia and TB. AIHA is treated with steroids, and in the presence of TB, it would result in adverse consequences [7, 8]. However, such consequences were not observed in any of the cases reviewed. Routine investigations confirmed the diagnosis of TB and AIHA, among the cases of this review.

Tuberculosis induced auto-immune-haemolytic-anaemia should be looked for, in patients presenting with pallor, lymphadenopathy and hepatosplenomegaly along with other symptoms of tuberculosis. This is important, especially in tuberculosis-endemic regions. Treatment with anti-tuberculosis medicines with steroids should be offered for such patients.




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