Autoimmune Hemolytic Anemia in a Patient with Acute Myelomonocytic Leukemia

Abstract

Autoimmune hemolytic anemia (AIHA) has been described in patients with lymphoid neoplasm with an etiologic relationship between the emergence of autoantibodies and lymphocyte dysfunction. Autoimmune disorders are less to develop in patients with other neoplasm like chronic myeloid leukemia, myelodysplastic syndrome or acute myeloid leukemia. Few reports have been documented the development of immune hemolytic anemia in patients with acute myeloid leukemia. We herein, present the case of de novo acute myelomonocytic leukemia associated with autoimmune hemolytic anemia. The patient has no previous medical history of anemia and Hb level at presentation was normal. She received chemotherapy containing Adriamycin plus Cytarabine. She showed marked improvement of anemia after steroid therapy with subsidence of all the clinical and laboratory manifestations of hemolysis when the patient went into remission. AIHA should be considered as one cause of anemia in de novo AML patients, and blood transfusions should be given carefully in such cases to avoid harmful hemolysis.

Morphological Diagnosis and Immunophenotypic Characterization of Onco-hematologic Malignancy (Acute Myelogenous Leukemia-M3 and M4): Two Pediatric Case Reports and Literature Review

“…The patient highlighted remarkable improvement for anemia after the steroid doses with declines in all clinical and laboratory findings of hemolysis when the patient went into abatement. A similar picture of AML-M4 with autoantibodies against erythrocytes with positive anti-human globulin test with the clue of hemolysis has been reported by Essa et al [12] The method of advancement of AIHA in de novo AML-M4 is muddled. A few reports hypothesize that an immune response was delivered against a tumor antigen expressed on malignant erythroblast derived erythrocytes.…”

“…Another clarification might be identified with the advancement of immunologic regulatory cells as suppressor T cells, which permitted the advancement of autoimmunity. [12] Eventually, morphological performance, positive myeloperoxidase, and alpha naphthyl acetate (non-specific esterase) indicated for AML-M4 and confirmed by positive immunophenotyping CD34, CD13, CD33, CD45, CD117, and HLA-DR for myeloid series and CD14, CD64, CD11c, CD11b, and HLA-DR for monocytoid series.…”