Immune hemolytic anemia--selected topics.
Autoimmune hemolytic anemia (AIHA) is most often idiopathic. However, in recent years, AIHA has been noted with increased incidence in patients receiving purine nucleoside analogues for hematologic malignancies; it has also been described as a complication of blood transfusion in patients who have also had alloimmunization. As the technology of hematopoietic stem cell transplantation has become more widespread, immune hemolysis in the recipients of ABO-mismatched products has become better recognized. The syndrome is caused by passenger lymphocytes transferred from the donor, and although transient, can be quite severe. A similar syndrome has been observed in recipients of solid organ transplants when there is ABO-incompatibility between donor and recipient. Venous thromboembolism is a little-recognized, though likely common, complication of autoimmune hemolytic anemia (AIHA), and may in some instances be related to coexistent antiphospholipid antibodies. While AIHA is a well-documented complication of malignant lymphoproliferative disorders, lymphoproliferative disorders may also paradoxically appear as a consequence of AIHA. A number of newer options are available for treatment of AIHA in patients refractory to corticosteroids and splenectomy. Newer immunosuppressives such as mycophenolate may have a role in such cases. Considerable experience has been accumulating in the last few years with monoclonal antibody therapy, specifically rituximab, in difficult AIHA cases; it appears to be a safe and effective option.
Hoffman
Philip C
PC
University of Chicago, 5841 S Maryland Ave, MC2115, Chicago, IL 60637, USA. phoffman@medicine.bsd.uchicago.edu
D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D001787:Blood Group Incompatibility / Q000150:complications; D004358:Drug Therapy; D019337:Hematologic Neoplasms / Q000150:complications / Q000209:etiology; D006648:Histocompatibility; D006801:Humans; D009705:Nucleosides / Q000009:adverse effects* / Q000627:therapeutic use
D009705:Nucleosides