Recurrent cold hemagglutinin disease following allogeneic bone marrow transplantation successfully treated with plasmapheresis, corticosteroid and cyclophosphamide.
A 10-year-old male with severe aplastic anemia following allogeneic BMT developed a hemolytic crisis on post-BMT day 67. The diagnosis of cold hemagglutinin disease was made based on the findings of anemia, reticulocytosis, positive direct Coombs test, and markedly elevated cold agglutinins. Anti-nuclear antibody and anti-DNA antibody were also increased. Plasmapheresis was effective as an emergency measure. Corticosteroid after plasmapheresis had a transient effect. At the second episode of hemolysis 6 months after BMT, immunosuppressive therapy with cyclophosphamide plus corticosteroid was successfully administered without negative effect on engraftment.
Azuma
E
E
Department of Pediatrics and Clinical Immunology, Mie University School of Medicine, Japan.
Nishihara
H
H
Hanada
M
M
Nagai
M
M
Hiratake
S
S
Komada
Y
Y
Sakurai
M
M
D000741:Anemia, Aplastic / Q000628:therapy; D000744:Anemia, Hemolytic, Autoimmune / Q000628:therapy*; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000628:therapy*; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D010956:Plasmapheresis; D011241:Prednisone / Q000627:therapeutic use*; D012008:Recurrence; D016879:Salvage Therapy; D014184:Transplantation, Homologous
D001323:Autoantibodies; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011241:Prednisone