Hemolytic Anemia in Pregnancy: A Rare and Challenging Case in Indonesia

Autoimmune hemolytic anemia (AIHA) is an infrequent etiology of anemia during pregnancy, and its occurrence in the postpartum period is even more uncommon. This study presents the case of a 27-year-old woman who exhibited severe anemia and thrombocytopenia six weeks after delivery. Hemolysis was confirmed upon evaluation, and a diagnosis of AIHA was established based on a positive direct antiglobulin test (DAT) and the presence of autoantibodies targeting red blood cells (RBCs). Treatment with steroids resulted in an improvement in the patient's hemoglobin levels. The demographic characteristics observed in our case align with prior research, which has documented mild anemia during pregnancy, lower gestational age, and decreased fetal birth weight in primary AIHA cases. Furthermore, thrombocytopenia can be manifested in AIHA during pregnancy, necessitating long-term monitoring of such patients. The AIHA rarity as a causative factor for anemia during pregnancy, particularly in the postpartum period, underscores the significance of including AIHA in the differential diagnosis for severe anemia. Moreover, extended follow-up care is essential for managing these patients. Employing a multidisciplinary approach to prenatal care facilitates the identification and management of rare complications, such as AIHA.