Tuberculosis and immune hemolytic anemia [letter]

We read with great interest the clinical brief by Gupta et al (February 2005) on "Abdominal tuberculosis with autoimmune hemolytic anemia". We do not agree with the statement that this is the first case report of tuberculosis with autoimmune hemolytic anemia. Anemia is present in 63% of miliary tuberculosis patients. There are several reports associating mycobacterial disease with anemia and several mechanisms have been proposed: nutritional deficiency failure of iron utilization malabsorption syndrome and marrow suppression. The association of autoimmune hemolytic anemia with tuberculosis although extremely rare is known for quite long. An early experimental study in Germany showed that the injection of tubercle bacilli or their products produce hemolytic anemia pancytopenia and myelofibrosis in small animals. To our knowledge since then 7 cases of autoimmune hemolytic anemia in association with tuberculosis have been reported in medical history. (excerpt)