Autoimmune Hemolytic Anemia:Focusing on Therapy According to Classification

Yilmaz, Fergun; Vural, Fılız

doi:10.15226/2372-0948/5/1/00156

Cited by 4 publications

(4 citation statements)

References 41 publications

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“…Steroids are the mainstay of treatment for AIHA, but the definitive treatment depends upon treating the underlying cause. Steroids are effective in 70-80% of patients [15][16][17]. The remaining 20-30% are steroid-resistant which usually give response to other immunosuppressive agents like azathioprine, infliximab, cyclophosphamide or intravenous immunoglobulins.…”

Section: Discussionmentioning

confidence: 99%

Cold autoimmune hemolytic anemia: a rare association with triple-positive breast cancer

Tauseef

Asghar

Zafar

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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A 45-year-old Asian woman was presented with fever, easy fatigability, shortness of breath, cervical and axillary lymphadenopathy and other signs and symptoms of anemia. After all the baseline work-up, the patient was investigated for Mono-coombs C3d levels, which were elevated, suggesting the diagnosis of Cold autoimmune hemolytic anemia (Cold AIHA). An Ultrasound-guided true-cut biopsy was done to determine the primary cause associated with it, which showed the presence of tumor cells arranged in cords and clusters. They have dark staining cells with mitotic activity, suggestive of breast carcinoma as an association of Cold AIHA. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were sent, which came out to be positive. So, the patient was diagnosed with Cold AIHA in association with triple-positive breast cancer.

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Section: Discussionmentioning

confidence: 99%

Cold autoimmune hemolytic anemia: a rare association with triple-positive breast cancer

Tauseef

Asghar

Zafar

et al. 2019

Journal of Community Hospital Internal Medicine Perspectives

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“…Besides another episode of steroid administration, splenectomy, rituximab and immunosuppressive agents are options in relapsed patients [20,21]. We treated sixteen patients with second line treatment (seven patients with rituximab, six patients with splenectomy, and three patients with azathioprine).…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Treatment Outcomes of Warm Autoimmune Hemolytic Anemia: A Retrospective Analysis of 60 Turkish Patients

Yilmaz

Kiper

Koç

et al. 2019

Indian J Hematol Blood Transfus

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We aimed to analyze 10-year experience of WAIHA patients at a single referral center in Turkey. Clinical data, survival outcome of sixty patients who were diagnosed with WAIHA were retrospectively analyzed. All the patients were direct antiglobulin test (DAT) positive. In 21 (30%) patients, IgG plus C3d DAT positivity was documented. 16 patients were secondary WAIHA and most common underlying causes were lymphoproliferative diseases (5 patients) and connective tissue disease (8 patients). Corticosteroids were first choice as a first line therapy with 54.5% CR and 40.2% PR rates. 43.3% of the patients relapsed after a median 12 months. In relapsed patients, rituximab and splenectomy achieved 85% overall response rates. The median OS was not reached. The median DFS was 40 months (95% CI, 19.6-60.4). OS and DFS at 36 months were 89.6% and 51.1%, respectively. DFS at 36 months was lower in patients with IgG plus C3d positive DAT than patients with only positive Ig G DAT (36 vs. 54%) but this difference could not reach statistical significance (p = 0.23). WAIHA was a rare disease with a good prognosis. Corticosteroids were the first option and splenectomy and rituximab received good responses in relapsed patients. Attention should be paid especially in patients with IgG plus C3d DAT positivity since lower DFS were reported. Characteristics and pathogenesis of patients with IgG plus C3d DAT positivity was still an obscure.

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“…Steroids are the mainstay of treatment for AIHA in addition to treating an underlying cause. Steroids are effective in 70–80% of patients [ 9 – 11 ]. The remaining 20–30% of steroid-unresponsive patients will require other treatment options [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Association of Autoimmune Hemolytic Anemia with Gastric Adenocarcinoma

Agrawal

Alfonso

2017

Case Reports in Oncological Medicine

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An 80-year-old male presented with dyspnea on exertion for at least two months. He also complained of progressive dysphagia and weight loss of 35 pounds over the last eight months. Initial blood tests showed hemoglobin of 6.1 g/dl, reticulocytes count of 19.7%, total bilirubin of 3.2 mg/dl, lactate dehydrogenase of 600 U/L, and haptoglobin of less than 8 mg/dl, and direct Coombs test was positive for warm immunoglobulin G. The impression was autoimmune hemolytic anemia (AIHA). The evaluation of dysphagia with esophagogastroduodenoscopy revealed a single irregular 4 cm malignant appearing ulcerated mass at the incisura angularis of the stomach. The mass was confirmed as adenocarcinoma on biopsy. Diagnostic laparoscopy was positive for malignant cells and he was diagnosed with stage IV adenocarcinoma of the stomach. Other extensive workup to determine the etiology of AIHA was negative (described in detail below). Surgery was deferred primarily due to metastasis of cancer. Initially, hemoglobin was stabilized by intravenous methylprednisolone, high dose immunoglobulins, and packed red blood cell transfusions. After a few weeks, hemoglobin started trending down again. The patient was weaned off steroids and paradoxically IgG-mediated autohemolysis was controlled with the initiation of palliative chemotherapy. Our case highlights a rare occurrence of AIHA in association with gastric adenocarcinoma.

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Autoimmune Hemolytic Anemia:Focusing on Therapy According to Classification

Cited by 4 publications

References 41 publications

Cold autoimmune hemolytic anemia: a rare association with triple-positive breast cancer

Cold autoimmune hemolytic anemia: a rare association with triple-positive breast cancer

Clinical Features and Treatment Outcomes of Warm Autoimmune Hemolytic Anemia: A Retrospective Analysis of 60 Turkish Patients

A Rare Association of Autoimmune Hemolytic Anemia with Gastric Adenocarcinoma

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