Splenic lymphoma presenting as warm autoimmune hemolytic anemia associated with pure red cell aplasia.
OBJECTIVE
Warm autoimmune hemolytic anemia (AIHA) is a condition in which peripheral red blood cell (RBC) destruction is induced by the presence of an autoantibody. Pure red cell aplasia (PRCA) represents an isolated process of decreased erythropoiesis. The combination of both is quite rare, with a very poor prognosis. We describe a patient with isolated splenic lymphoma whose presentation was a combination of AIHA and PRCA. The patient was resistant to all treatment.


METHODS
Erythroid colony assays were performed, in order to compare the effect of the patient's serum on colonies with that of a normal control.


RESULTS
The patient's serum significantly suppressed normal erythroid colony growth. A red cell eluate revealed the presence of a warm autoantibody.


CONCLUSIONS
The patient's serum contained warm autoantibody responsible for peripheral RBC destruction and a humoral factor, perhaps the warm autoantibody, which suppressed bone marrow erythropoiesis. Establishing an early diagnosis, and treatment of the underlying disease might result in a better prognosis.
Zeidman
A
A
Department of Medicine B, Golda (Hasharon) Campus, Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Petah-Tikva, Israel.
Fradin
Z
Z
Barac
Y
Y
Bendayan
D
D
Mittelman
M
M
Orlin
J
J
D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000097:blood / Q000494:pharmacology; D002455:Cell Division / Q000187:drug effects; D003298:Coombs Test; D003937:Diagnosis, Differential; D015672:Erythroid Precursor Cells / Q000166:cytology / Q000502:physiology; D004921:Erythropoietin / Q000494:pharmacology; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000097:blood / Q000175:diagnosis*; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D018805:Sepsis / Q000209:etiology; D013156:Splenectomy; D013160:Splenic Neoplasms / Q000097:blood / Q000175:diagnosis*
D000970:Antineoplastic Agents; D001323:Autoantibodies; D004921:Erythropoietin