Retrospective analysis of 30 severe autoimmune hemolytic anemia patients treated by whole blood exchange transfusion.
BACKGROUND
Autoimmune hemolytic anemia (AIHA) results from the excessive destruction of red blood cells (RBCs). Nowadays, there is no exact treatment for severe AIHA and our current medical therapies do not effectively stop the progression of severe AIHA. Therapeutic plasma exchange (TPE) is used as emergency therapy that is sometimes helpful. Whole blood exchange (WBE) is based on TPE while its replacement liquids are donor RBCs and fresh plasma. We hypothesized that WBE transfusion might be able to control the process of acute hemolysis, avoid the hemolytic crisis, and improve severe hemolytic anemic symptoms rapidly. The objective was to investigate the efficiency of WBE on severe AIHA.


METHODS
Thirty severe AIHA patients were treated with WBE in our hospital from June 2003 to August 2013. An apheresis instrument (COBE Spectra, TerumoBCT) was employed in WBE procedure. We retrospectively analyzed the results of these severe anemic patients.


RESULTS
Twelve hours after WBE treatment, 26 of 30 (86.7%) patients' Hb levels were elevated immediately. Their total bilirubin concentration, direct bilirubin levels, and titers of antibodies were decreased, and clinical symptoms were relieved rapidly. Two (6.7%) patients' hemolysis was stopped from deteriorating, one (3.3%) patient's hemolysis was not controlled by the treatment due to malignancy, and another (3.3%) patient died from pleural hemorrhage of Evans syndrome.


CONCLUSIONS
This study suggests that WBE is an effective therapy for severe AIHA. Further investigation of this application is warranted.
Blood Transfusion Department, Xiangya Hospital, Central South University, Changsha, China.
Bi-Juan
BJ
Li
Blood Transfusion Department, Xiangya Hospital, Central South University, Changsha, China.
Xi
X
Yuan
Blood Transfusion Department, Xiangya Hospital, Central South University, Changsha, China.
Yuan-Jun
YJ
Jiang
Blood Transfusion Department, Xiangya Hospital, Central South University, Changsha, China.
Ning-Li
Blood Transfusion Department, Xiangya Hospital, Central South University, Changsha, China.
Xiang-Wu
XW
Shu
Blood Transfusion Department, Xiangya Hospital, Central South University, Changsha, China.
Kai-Liang
KL
Liu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood* / Q000628:therapy*; D001323:Autoantibodies / Q000097:blood*; D001663:Bilirubin / Q000097:blood*; D001803:Blood Transfusion; D002648:Child; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies
D001323:Autoantibodies; D001663:Bilirubin