title: [Cold autoimmune hemolytic anemia complicated with relapsed myelodysplastic syndrome after allogeneic hematopoietic cell transplantation].
abstract: Myelodysplastic syndrome (MDS) is known to often be complicated by a range of autoimmune diseases. We herein present a case with MDS complicated by cold autoimmune hemolytic anemia (cold AIHA). The patient was a 51-year-old woman. She was diagnosed with MDS (refractory cytopenia with multilineage dysplasia) in May 2009. In January 2010, she underwent unrelated allogeneic bone marrow transplantation but was re-admitted in October 2010 for treatment of relapsed MDS. Despite daily transfusions of red blood cells, her anemia failed to improve. Her laboratory examinations showed a low haptoglobin level and elevation of indirect bilirubin and LDH. The direct Coombs test was positive at a low and at room temperature and cold agglutinin was negative. After confirming the diagnosis of cold AIHA, all transfusion fluids were warmed but her anemia still failed to improve. In addition to the warmed transfusion fluids, we administered corticosteroids, immunosuppressive agents and high-dose intravenous immunoglobulin infusions. This management strategy ameliorated the patient's hemolytic anemia. To our knowledge, MDS cases complicated by cold AIHA are rare. Our patient thus provides a valuable contribution to medical knowledge.
authors.affiliation: Hematology, Graduate School of Medicine, Osaka City University.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okamura
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nakane
authors.forename: Keizo
authors.initials: K
authors.lastname: Fujino
authors.forename: Shiro
authors.initials: S
authors.lastname: Koh
authors.forename: Takuro
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Nishimoto
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Hideo
authors.initials: H
authors.lastname: Koh
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Nakao
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Nakamae
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
mesh_terms: D064591:Allografts; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001853:Bone Marrow / Q000473:pathology*; D003080:Cold Temperature; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome