Coombs-positive autoimmune hemolytic anemia in ulcerative colitis

Coombs-positive autoimmune hemolytic anemia is a rare complication of ulcerative colitis, occurring in fewer than 1% of cases. We have found eight patients with autoimmune hemolytic anemia in a series of 1150 hospitalized patients with ulcerative colitis (0.7%). There was a marked preponderance of female patients F:M=7:1, in accord with previous reports. The hemolytic anemia appeared at a mean of 10 years after the onset of colitis, apparently independent of the age of the patient. Although seven of the eight patients had active colitis at the time of diagnosis of anemia, there was no consistent relationship to the extent of the bowel disease. Seven of the eight patients survived. One patient showed a partial response to steroid therapy, two responded to splenectomy, but four required both colectomy and splenectomy. Steroids should be the first line of therapy followed by splenectomy, if necessary. For those patients who have severe colitis, which in itself would merit surgery, a total proctocolectomy combined with splenectomy seems advisable.