title: The effect of erythropoiesis-stimulating agents in patients with therapy-refractory autoimmune hemolytic anemia.
abstract: BACKGROUND
  Many patients with autoimmune hemolytic anemia (AIHA) do not respond to standard therapy and/or may develop severe complications which can be of fatal outcome. There is some evidence that erythropoiesis-stimulating agents (ESAs) may be helpful in the management of such patients.
  
  
  METHODS
  We describe the effect of ESAs in 12 new patients with therapy-refractory AIHA (7 of warm type and 5 of cold type) and review 5 previously reported cases. Serological testing was performed using standard methods.
  
  
  RESULTS
  All patients responded well to treatment with ESAs. At least 5 of the 17 patients demonstrated complete recovery, and none of the patients developed significant adverse reactions due to treatment with ESAs.
  
  
  CONCLUSIONS
  The mechanism by which ESAs improves hemolysis in AIHA is not completely clear. In addition to increased production and prolonged RBC survival, it may inhibit eryptosis (programmed cell death). ESAs represent a new option in the treatment of decompensated and/or refractory AIHA of warm and cold type. However, more information is required to assess which patients can be treated with ESAs.
authors: Institute of Transfusion Medicine, Charité-Universitätsmedizin - Campus Virchow-Klinikum, Berlin, Germany.
authors: Abdulgabar
authors: A
authors: Salama
authors: Department for Internal Medicine / Hematology and Oncology. Evangelisches Krankenhaus Wesel, Wesel, Germany.
authors: Dirk
authors: D
authors: Hartnack
authors: Clinic for Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany.
authors: Hans-Walter
authors: HW
authors: Lindemann
authors: Gemeinschaftspraxis und Tagesklinik für Hämatologie und Internistische Onkologie, Stralsund, Germany.
authors: Hans-Joachim
authors: HJ
authors: Lange
authors: Department of Hematology-Oncology, University Hospital Gießen and Marburg, Gießen Campus, Gießen, Germany.
authors: Mathias
authors: M
authors: Rummel
authors: Clinic for Hematology and Oncology, Charité-Universitätsmedizin - Campus Virchow-Klinikum, Berlin, Germany.
authors: Andreas
authors: A
authors: Loew
keywords: AIHA; Autoimmune hemolytic anemia; EPO; Erythropoietin