Warm Auto-antibodies resulting in a Transfusion Reaction in a setting of ANCA-associated Renal Failure Christopher O. Alabi1, Haroon Nawaz1, Pallavi Aneja1, Adekunle O. Bamgboye2

1Westside Regional Medical Center, Plantation, FL 2Northwest Medical Center, Margate, FL Abstract Introduction ANCA-associated renal failure and presence of warm auto-antibodies are two fairly uncommon pathologies without any known connection especially because the cause of each one is not well understood so far. We report an uncommon tandem of ANCA-vasculitis and warm auto-immune hemolytic anemia (AIHA). Case description A 79-year-old retired lady presented at the ED with gradually worsening fatigue, anemia, and new onset renal failure. Asides from well controlled hypertension, she had been healthy all her life and all previous blood parameters had always been within normal limits. At admission, she was pale but not jaundiced. Pertinent laboratory findings include: elevated BUN and creatinine, hematuria, mild proteinuria and anemia. Additional laboratory findings include a positive Coombs’ test, positive P-ANCA and her renal biopsy revealed pauci-immune crescentic glomerulonephritis. Bone marrow aspiration was normal. She was noted to have warm auto-antibodies during blood typing and cross-matching. She had a mild self-limited reaction of fever and back pain within 15 minutes when she was transfused with the best-matched packed red cells. As a result, the transfusion had to be stopped. She was subsequently treated with rituximab, cyclophosphamide, steroids, washed RBC transfusions, IV erythropoietin and courses of dialysis. Discussion AIHA is only seen in about 1-3 persons per 100,000/year. It is also not a common occurrence to see a transfusion reaction attributable to warm antibodies in a patient. The rarity of the ANCA-positive, pauci-immune crescentic glomerulonephritis seen in this same patient possibly raises more questions. To the best of our knowledge, a combination of these conditions has not been reported in one single episode of illness. We report this to add to the known body of knowledge and provide basis for further study if more patients present with a similar picture later in the course of time. Keywords: warm antibodies, auto-immune hemolytic anemia, transfusion reaction, P-ANCA, crescentic glomerulonephritis. There is no conflict of interest involving any author and no grant was required for this article.