Cold Autoimmune Hemolytic Anemia due to High-grade non Hodgkin's B cell Lymphoma with Weak Response to Rituximab and Chemotherapy Regimens.
Autoimmune hemolytic anemia (AIHA) is characterized by shortening of red blood cell (RBC) survival and the presence of autoantibodies directed against autologous RBCs. Approximately 20% of autoimmune hemolytic anemia cases are associated with cold-reactive antibody. About half of patients with AIHA have no underlying associated disease; these cases are termed primary or idiopathic. Secondary cases are associated with underlying diseases or with certain drugs. We report herein a rare case of cold autoimmiune hemolytic anemia due to high-grade non-Hodgkin's lymphoma of B-cell type with weak response to rituximab and chemotherapy regimens. For treatment B cell lymphoma, Due to lack of treatment response, we used chemotherapy regimens including R- CHOP for the first time, and then Hyper CVAD, R- ICE and ESHAP were administered, respectively. For treatment of autoimmune hemolytic anemia, we have used the corticosteroid, rituximab, plasmapheresis and blood transfusion and splenectomy. In spite of all attempts, the patient died of anemia and aggressive lymphoma nine months after diagnosis. To our knowledge, this is a rare report from cold autoimmune hemolytic anemia in combination with high-grade non-Hodgkin's lymphoma of B-cell type that is refractory to conventional therapies.
Emam Reza Hospital, Hamadan University of Medical Sciences, Hamadan, Iran ; Blood transfusion research center, High institute for research and Education in Transfusion Medicine, Tehran, Iran.
Behzad
B
Nazel Khosroshahi
Department of Pathology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Mohammad
M
Jafari
Department of nursing, Hamedan branch, Islamic Azad University, Hamedan, Iran.
Hossein
H
Vazini
Department of Hematology and Oncology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
Alireza
A
Ahmadi
Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Keivan
K
Shams
Department of Mycology, School of Medicine, Tarbiat Modares University, Tehran, Iran.
Mahdi
M
Kholoujini
Chemotherapy; Cold autoimmune hemolytic anemia; High-grade; Rituximab; non-Hodgkin's lymphoma