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 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 mofetil may have a role in such cases. Considerable experience has been accumulating in the last few years with monoclonal antibody therapy, mainly rituximab, in difficult AIHA cases; it appears to be a safe and effective option.
Hoffman
Philip C
PC
University of Chicago, Chicago, IL 60637, USA. phoffman@medicine.bsd.uchicago.edu
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000744:Anemia, Hemolytic, Autoimmune / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000601:surgery; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D001787:Blood Group Incompatibility / Q000150:complications; D017338:Cladribine / Q000009:adverse effects; D003131:Combined Modality Therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents / Q000145:classification / Q000627:therapeutic use; D016131:Lymphocyte Subsets / Q000276:immunology / Q000637:transplantation; D008232:Lymphoproliferative Disorders / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology; D000069283:Rituximab; D013156:Splenectomy; D065227:Transfusion Reaction; D014180:Transplantation / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000009:adverse effects; D054556:Venous Thromboembolism / Q000209:etiology; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D017338:Cladribine; D000069283:Rituximab; D014740:Vidarabine; C024352:fludarabine