Immune hemolytic anemia--selected topics

Hematology Am Soc Hematol Educ Program. 2009:80-6. doi: 10.1182/asheducation-2009.1.80.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Anemia, Hemolytic, Autoimmune* / chemically induced
  • Anemia, Hemolytic, Autoimmune* / complications
  • Anemia, Hemolytic, Autoimmune* / drug therapy
  • Anemia, Hemolytic, Autoimmune* / immunology
  • Anemia, Hemolytic, Autoimmune* / surgery
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Murine-Derived
  • Antimetabolites, Antineoplastic / adverse effects
  • Blood Group Incompatibility / complications
  • Cladribine / adverse effects
  • Combined Modality Therapy
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Humans
  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents / classification
  • Immunosuppressive Agents / therapeutic use
  • Lymphocyte Subsets / immunology
  • Lymphocyte Subsets / transplantation
  • Lymphoproliferative Disorders / complications
  • Postoperative Complications / etiology
  • Rituximab
  • Splenectomy
  • Transfusion Reaction
  • Transplantation / adverse effects
  • Transplantation, Homologous / adverse effects
  • Venous Thromboembolism / etiology
  • Vidarabine / adverse effects
  • Vidarabine / analogs & derivatives

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antimetabolites, Antineoplastic
  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents
  • Cladribine
  • Rituximab
  • Vidarabine
  • fludarabine