Autoimmune hemolytic anemia (AIHA) is a heterogeneous and relatively unknown disease caused by premature immune destruction of red blood cells. While its occurrence is uncommon among children, it is sometimes severe and resistant to treatment. The warm-reactive type contains 70% to 80% of all cases, in which the first-line treatment is considered to be a steroid. Moreover, splenectomy, rituximab (a monoclonal antibody), and immunosuppressive drugs are used in refractory cases, with unclear efficacy and deep suppression of the immune system, which consequently lead to various side effects. This study reports the successful treatment of a life-threatening case using a new method. In this regard, it was stated that using the capacity of Iranian traditional medicine (ITM) as one of the complementary therapies can help in the treatment of this disease.
In this case report, we documented the successful treatment of a severe and refractory warm AIHA in a boy, who was resistant to the currently recommended treatments such as corticosteroids, rituximab, and cyclosporine at different time periods. Based on ITM, a novel treatment was performed, which was daily swallowing 4-6 live small freshwater fishes (from Cyprinidae family) for an eight-week period and later being tapered. As a result, this treatment had a rapid response time with no side effects. At the time of performing this study, the patient was in his 5th-year disease-free period. For future research, we recommend the researchers to study the use of this novel treatment in case of resistance to the current established therapies of warm AIHA disease.