Case Report
Rheumatoid Arthritis and Autoimmune Hemolytic Anemia as First Manifestation of Rhupus
| | Variable (normal range) | On admission | After four weeks |
| | Creatinine (0.57–1.11 mg/dL) | 0.70 mg/dL | 0.66 mg/dL | | Uric acid (mg/dL) | 6.4 mg/dL | — | | LDH (120–246 U/L) | 272 U/L | 189 U/L | | Total bilirubin (0.00–0.90 mg/dL) | 1.3 mg/dL | 0.5 mg/dL | | Indirect bilirubin (0.00–0.80 mg/dL) | 0.9 mg/dL | 0.4 mg/dL | | Serum potassium (3.50–5.10 mEq/L) | 3.59 mEq/L | 3.73 mEq/L | | Serum sodium (136–145 mEq/L) | 144 mEq/L | 140 mEq/L | | Serum chloride (98–107 mEq/L) | 107 mEq/L | 107 mEq/L | | Hemoglobin (13–18 g/dL) | 5.6 g/dL | 12.8 g/dL | | Hematocrit (42–53.6%) | 18.1% | 39.2% | | Platelets (150–450 × 103/μL) | 337 × 103/μL | 318 × 103/μL | | MCV (80–97 fL) | 99.8 fL | 99.5 fL | | MCH (27–31 pg) | 31.1 pg | 32.5 pg | | Reticulocyte count (0.8–2.3%) | 22.2% | 2.8% | | Erythrocyte sedimentation rate (mm/h) | 10 mm/h | 33 mm/h | | C3 (90–170 mg/dL) | 71 mg/dL | 95.60 mg/dL | | C4 (12–36 mg/dL) | 11.70 mg/dL | 23.20 mg/dL | | C-reactive protein (0-00–1.00 mg/dL) | 1.26 mg/dL | 0.31 mg/dL | | Rheumatoid factor (0.00–14.00 IU/mL) | 61.8 IU/mL | — | | Fibrinogen (mg/dL) | 300 mg/dL | — | | Iron (33–193 μg/dL) | 153 μg/dL | — | | Ferritin (4–104.2 ng/mL) | 258 ng/mL | — | | Direct Coombs test | Positive | — | | Serologic findings (direct antiglobulin test or antibody screen results) | IgG+, C3b, C3d | — | | Antinuclear antibody | 1 : 2520, homogeneous pattern | — | | Anti-dsDNA antibody (0–200 IU/mL) | 479.23 IU/mL | 205.63 | | Anticitrullinated peptide antibody (U/mL) | 188.50 IU/mL | | | Anti-Smith antibody | Negative | | | Antiphospholipid antibody | Negative | | | Anti-beta 2 glycoprotein 1 | — | Negative (IgG, IgM) | | Lupus anticoagulant antibody | — | Negative |
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LDH, lactate dehydrogenase; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; C3, complement 3; C4, complement 4; Anti-dsDNA antibodies, anti-double-stranded DNA antibodies.
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