21. Clinical Course

  • Marrow - erythroid hyperplasia without other pathology

  • DIAGNOSIS: warm autoimmune hemolytic anemia (AIHA); he was started on prednisone.

  • He was transfused with 4 RBC units on day 2 of admission when his Hct dropped to 14%. Hemolysis continued, requiring 2 to 4 RBC units/d despite steroids. He eventually received Imuran and subsequently vincristine, to which he finally responded.

  • Total number of RBC units received was 25.

  • During this admission, the patient developed methicillin-resistant staphylococcal infection, successfully treated with levofloxacin and vancomycin.

  • Breakpoint #3:
    Is there a unifying disease entity for this patient and how can this be established?