Korean J Hematol.  2011 Dec;46(4):274-278. 10.5045/kjh.2011.46.4.274.

Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency

• Park MY
• Kim JA
• Yi SY
• Chang SH
• Um TH
• Lee HR

• KMID: 2251989
• DOI: http://doi.org/10.5045/kjh.2011.46.4.274

Abstract

Splenic infarction is most commonly caused by cardiovascular thromboembolism; however, splenic infarction can also occur in hematologic diseases, including sickle cell disease, hereditary spherocytosis, chronic myeloproliferative disease, leukemia, and lymphoma. Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia (AIHA). We report a case of a 47-year-old woman with iron deficiency anemia who presented with pain in the left upper abdominal quadrant, and was diagnosed with AIHA and splenic infarction. Protein C activity and antigen decreased to 44.0% (60-140%) and 42.0% (65-140%), respectively. Laboratory testing confirmed no clinical cause for protein C deficiency, such as disseminated intravascular coagulation, sepsis, hepatic dysfunction, or acute respiratory distress syndrome. Protein C deficiency with splenic infarction has been reported in patients with viral infection, hereditary spherocytosis, and leukemia. This is a rare case of splenic infarction and transient protein C deficiency in a patient with AIHA.

Keyword

Autoimmune hemolytic anemia; Protein C deficiency; Splenic infarction

MeSH Terms

Anemia, Hemolytic, Autoimmune
Anemia, Iron-Deficiency
Anemia, Sickle Cell
Disseminated Intravascular Coagulation
Female
Hematologic Diseases
Humans
Leukemia
Lymphoma
Middle Aged
Protein C
Protein C Deficiency
Respiratory Distress Syndrome, Adult
Sepsis
Spherocytosis, Hereditary
Splenic Infarction
Protein C

Figure

• 

  Fig. 1 (A) Initial abdominal CT revealed splenomegaly without evidence of splenic infarction. (B) Follow-up abdominal CT revealed a wedge-shaped multifocal low-attenuated portions with a well-defined margin, suggesting splenic infarction in a hypertrophic spleen.

• 

  Fig. 2 The spleen showing multifocal, well-demarcated, pale, wedge-shaped subcapsular infarcts.

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