Babesia infection triggers autoimmune blood cell disorder

Autoimmune hemolytic anemia (AIHA) is a rare red blood cell disorder that occurs when antibodies directed against a person’s own red blood cells cause them to burst, leading to insufficient concentration in the blood. The disorder has only rarely been associated with a Babesia infection.

An elderly man, with an intact spleen, was admitted to the hospital with fatigue, lightheadedness, joint pain in his shoulder and hips, and stomach discomfort that had been ongoing for 2 weeks. He also reported having difficulty urinating, one episode of chills and pain in his lower left back.

Bleik and colleagues describe the case in their article “Warm Autoimmune Hemolytic Anemia Secondary to Babesia Microti Infection: A Case Report.”¹

“The case presented is a rare presentation of babesiosis-associated wAIHA in an individual with a functioning spleen.”

Laboratory testing revealed acute anemia and mild thrombocytopenia.

Additional testing for Lyme disease and other tick-borne illnesses was performed, since the patient reported spending time outdoors in a tick endemic region.

Test results were positive for Babesia microti. “…our final diagnosis was wAIHA due to babesiosis,” the authors state.

The patient’s symptoms resolved completely following Babesia treatment with atovaquone and azithromycin, along with Prednisone.  

“As the number of reported babesiosis cases increases, there is a need to create more awareness of some atypical presentations that allow for early recognition and treatment.”

Babesia is the tick-borne infections most likely to be associated with hemolysis, the authors explain. “However, it is unusual for babesia-related hemolysis to be due to AIHA, particularly in immunocompetent patients with intact spleens.”

[Note: Hemolysis refers to the destruction of red blood cells.]

“This case aims to raise clinical suspicion and consideration for babesiosis in elderly immunocompetent individuals who present with wAIHA regardless of spleen presence, particularly if they have been to endemic areas.”

The authors point out, “In babesia-associated wAIHA, a combination of standard therapy for babesiosis may be enough to mitigate the hemolysis; however, in some cases, adding standard wAIHA therapy may be indicated.”