Refractory Sideroblastic Anemia Secondary to Autoimmune Hemolytic Anemia

Abstract

A 75-year-old woman was hospitalized with autoimmune hemolytic anemia. During a period of 22 months the patient had six hemolytic crises which responded to treatment with prednisone and azathioprine. During the last admission the patient presented a sideroblastic anemia with 98% of ‘ring sideroblasts’ in the bone marrow. This association has never, to our knowledge, been reported before. It is possible that the immunosuppression played a definite role in the development of this sideroblastic anemia

Inflammatory and Immune Disorders Associated with Myelodysplastic Syndromes

“…In 1977, Celada et al first reported the case of a 75-year old man who developed refractory sideroblastic anemia secondary to autoimmune hemolytic anemia (AIHA), suggesting a possible association between MDS and autoimmune phenomenon [101]. According to the main series, autoimmune cytopenias have been documented in 1 to 16% of cases [13,14,102].…”

Marrow failure with sideroblasts in an autoimmune haemolytic crisis

“…Folic acid assays were not done. Celada, Farquet and Muller (1977) reported chronic haemolysis, reticulocytopenia and a sideroblastic marrow in an elderly patient on immunosuppressives. Our case is noteworthy because previous and follow-up marrow aspirates showed no abnormality of the red cell precursors.…”

The burden of autoimmunity in myelodysplastic syndromes

“…It is difficult to unequivocally identify the first reports of autoimmune manifestations reported in MDS patients, as the functional link between the 2 conditions was not clearly hypothesised until some years ago. For instance, in 1977, the development of refractory sideroblastic anaemia was interpreted as secondary to autoimmune haemolytic anaemia (AHA) in one of the first ever descriptions in this field . Since then, a number of pleomorphic clinical pictures have been reported, as shown in Table .…”

“…The first reports describing a possible association between MDS and AHA date back to the late 1970s, when the former was erroneously interpreted as a possible complication of the autoimmune phenomenon. 9,10 Beside sporadic cases reported both in the adult 11,12 and in the paediatric population, 13 a few studies have addressed the potential association between MDS and AHA within a more systematic approach. In particular, AHA was demonstrated in 7 out of 156 patients who received several transfusions as supportive therapy.…”

“…For instance, in 1977, the development of refractory sideroblastic anaemia was interpreted as secondary to autoimmune haemolytic anaemia (AHA) in one of the first ever descriptions in this field. 9 Since then, a number of pleomorphic clinical pictures have been reported, as shown in Table 1. Although the most frequent scenarios are AHA and vasculitis, the potential involvement of several different sites and organs has been described.…”