Mixed-type autoimmune hemolytic anemia following fludarabine treatment in a patient with chronic lymphocytic leukemia/small cell lymphoma.
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.
Vick
D J
DJ
Department of Pathology, Walter Reed Army Medical Center, Washington, DC 20307, USA. djvick615@POL.NET
Byrd
J C
JC
Beal
C L
CL
Chaffin
D J
DJ
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
D000970:Antineoplastic Agents; D001323:Autoantibodies; D014740:Vidarabine; C024352:fludarabine