title: Mixed-type autoimmune hemolytic anemia following fludarabine treatment in a patient with chronic lymphocytic leukemia/small cell lymphoma.
abstract: OBJECTIVE
  Mixed-type autoimmune hemolytic anemia (AIHA) is a rare complication of chronic lymphocytic leukemia (CLL). We report a patient with small lymphocytic lymphoma (phenotypic CLL) who developed symptomatic anemia 3 weeks after her fifth cycle of fludarabine, a T cell immunosuppressant.
  
  
  METHODS
  An antibody screen and panel, direct antiglobulin test, rapid acid eluate, rabbit erythrocyte stroma (RESt) adsorption, and autoadsorption were performed.
  
  
  RESULTS
  Warm and cold autoantibodies were detected. prompt treatment with corticosteroids and minimal blood transfusions led to marked improvement.
  
  
  CONCLUSIONS
  Normally, T cells suppress polyclonal lymphocytes that produce autoantibodies. Suppression of T cells in this patient, in addition to the underlying disease process, may explain this mixed-type AIHA, the first reported case to occur following fludarabine treatment.
authors.affiliation: Department of Pathology, Walter Reed Army Medical Center, Washington, DC 20307, USA. djvick615@POL.NET
authors.forename: D J
authors.initials: DJ
authors.lastname: Vick
authors.forename: J C
authors.initials: JC
authors.lastname: Byrd
authors.forename: C L
authors.initials: CL
authors.lastname: Beal
authors.forename: D J
authors.initials: DJ
authors.lastname: Chaffin
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001323:Autoantibodies / Q000032:analysis; D003298:Coombs Test; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000188:drug therapy*; D008875:Middle Aged; D013696:Temperature; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001323:Autoantibodies; D014740:Vidarabine; C024352:fludarabine