Blood Res 2019; 54(2): 86-86  https://doi.org/10.5045/br.2019.54.2.86
Evans syndrome diagnosed after traumatic subdural hemorrhage
Christopher S. Hong1, Mark M. Landreneau2,3, Ryan A. Grant1,4
Departments of 1Neurosurgery and 2Neurology, Yale School of Medicine, New Haven, 3Department of Medicine, Trinity Health of New England Medical Group, Hartford, CT, 4Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
Correspondence to: Christopher S. Hong, M.D.,
Department of Neurosurgery, Yale School of Medicine, 15 York Street, LCI8 New Haven, CT 06510, USA, E-mail: christopher.hong@yale.edu
Received: October 1, 2018; Revised: December 4, 2018; Accepted: December 26, 2018; Published online: June 30, 2019.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 

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A 75-year-old woman with hypertension presented with week-long malaise and diarrhea after a fall. Head computed tomography revealed a 1.5-cm-sized right-sided subdural hemorrhage with central hypodensity (arrows, A and B), which was concerning for active extravasation. Her platelet count was 8,000/µL; hemoglobin level was 3.9 g/dL. She was neurologically intact besides slight left-sided weakness. She received platelet and red blood cell transfusion within the first 24 hours; platelet count then increased to 55,000/µL and hemoglobin level to 7.7 g/dL. Blood smear demonstrated giant platelets with abundant rouleaux bodies, spherocytes, and some nucleated red blood cells. Laboratory test results showed 100% reticulated platelets, elevated reticulocyte count (9.33%), and 3+ positive Coombs test with warm autoimmune antibodies, indicating autoimmune hemolytic anemia with immune thrombocytopenia or Evans syndrome. Intravenous immunoglobulin was administered, followed by oral prednisone. Her subdural hemorrhage and clinical examination findings remained stable; thus, neurosurgery was not required. Test results for secondary causes of immune thrombocytopenia were unremarkable, including lupus, rheumatoid arthritis, hepatitis C, antiphospholipid syndrome, and autoimmune thyroid disease. Intracranial hemorrhage, albeit an unusual presentation of Evans syndrome, may be managed conservatively with prompt hematologic consultation and aggressive platelet repletion in the initial undiagnosed setting, followed by definitive immunosuppression.



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