Diagnostic dilemma in pediatric hemolysis: A case of mixed autoimmune hemolytic anemia

Abstract

Mixed autoimmune hemolytic anemia (AIHA) is an uncommon entity in childhood, characterized by overlapping clinical and laboratory features of both warm and cold AIHA. We describe the case of an eight-year-old boy who presented with profound anemia, discrepancies in blood grouping, and crossmatch incompatibility. Subsequent evaluation revealed the presence of warm- and cold-reactive autoantibodies following an upper respiratory tract infection, confirming the diagnosis of mixed AIHA. To our knowledge, this represents only the third reported pediatric case of mixed AIHA triggered by a respiratory infection. Early recognition is essential, as management parallels that of warm AIHA, with prompt initiation of corticosteroid therapy, adequate supportive measures, and careful long-term follow-up required to improve outcomes.