Autoimmune Cytopenias

Presentation and Management

A 28-year-old female with a history of immune thrombocytopenia (ITP) was referred to the hematology department of a medical center after moving to the United States from Brazil in July 2018. She reported having been diagnosed with ITP at 11 years of age. Complications that she had experienced from ITP included petechiae, heavy and/or prolonged menses, gastrointestinal bleeding, and epistaxis. Since her diagnosis at age 11, she had been managed on varying doses of prednisone, ranging from 10 mg to 60 mg by mouth once daily, and her disease was relatively stable. While living in Brazil, she had also received 2 prior courses of rituximab and undergone a splenectomy, with no lasting effect. Her previous hematologist in Brazil had attempted to initiate treatment with eltrombopag; due to financial constraints, however, she could not obtain the medication and therefore moved the United States for further care.

Presentation and Diagnosis

A 40-year-old male with a past medical history significant for type II diabetes mellitus (T2DM), hyperlipidemia, and untreated HIV presented to the emergency department on 7/18/2021 with a blood glucose level of 463 mg/dL. He reported headaches, dizziness, and diarrhea and had experienced 3 episodes of epistaxis over the 3 days prior.

Presentation and Diagnosis

A 45-year-old Caucasian male was diagnosed with autoimmune hemolytic anemia (AIHA) in March 2015 during workup for a syncopal event. At presentation, his hemoglobin level was 6 g/dL and his platelet count was 120,000/µL. His medical history was significant for obesity, diabetes, and immune thrombocytopenia (ITP). His ITP was diagnosed in October 2004 and treated only with intravenous immunoglobulin (IVIg) in 2004, 2008, and 2014. He did not require treatment for chronic ITP.

Presentation

A 62-year-old male with a past medical history significant for hypertension, diabetes mellitus, hyperlipidemia, and a recent COVID-19 infection...