Evans syndrome: a rare cause of anemia in the elderly. Martin-Kleisch A. (1), Lemaire E. (1), Zulfiqar AA. (1) 1. Department of Internal Medicine and Geriatrics, University Hospital of Reims, France
Introduction Anemia in the elderly remains a major problem and the causes are large and varied. Deficiences are the most common etiologies, but other pathologies must be sought.
Case Report We received a 87 year old patient for ischemic stroke. She had a history for hypertension treated and phlebitis. Neurological examination showed a right pyramidal syndrome associated with a complete right hemiplegia without facial involvement. The skin examination showed a slight livedo in the lower limbs. Laboratory tests showed anemia and thrombocytopenia initially not known. Cerebral scan confirmed ischemic stroke. Given these disturbed investigations, we have made a report showing a positive Combs test IgG + C3d associated with a collapsed haptoglobin, increased free bilirubin and increased Ddimeres (> 10.00mg / L). Antiplatelet antibodies were also positive (IgG + IgM). These results confirmed a mixed autoimmune hemolytic anemia associated with autoimmune thrombocytopenia and going in the direction of an Evans syndrome. An assessment of immune dysfunction has been prescribed, including the search for lupus or antiphospholipid syndrome, which can move in the direction of a Sneddon syndrome. Unfortunately, it has not been possible before the sudden deterioration and death of the patient.
Etiologies of Anemia in elderly
Based on the study of 80 patients in a geriatric care during 3 month.
Discussion Evans syndrome is a rare chronic hemtalogical disorder characterized by the simultaneous or sequential combination with an hemolityc anemia and immune thrombocytopenic purpura and sometimes an autoimmune neutropenia.
Conclusion Dysimmune pathologies are also found in the elderly and must be sought before symptoms suggestive for the establishment of a cure.
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