P31 Mixed-Type Autoimmune Haemolytic Anemia (AIHA)
| Autor: | A. Lakhani, M. Needs, V. Keevil, D. Tiwari, Nay Win |
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| Rok vydání: | 2006 |
| Předmět: | |
| Zdroj: | Transfusion Medicine. 16:38-38 |
| ISSN: | 1365-3148 0958-7578 |
| DOI: | 10.1111/j.1365-3148.2006.00694_31.x |
| Popis: | The diagnosis of mixed-type AIHA is based on demonstrating the presence of ‘warm’ IgG auto-antibody and high thermal amplitude ‘cold’ IgM auto-antibody reacting at or >30 °C. Mixed-type AIHA is uncommon. In general, patient with mixed-type AIHA responds to steroids and reported to be associated with SLE and lymphoma. Awareness of this condition is important as management may be different from either treating warm AIHA or cold haemmagglutinin disease (CHAD). We report two unusual cases of mixed-type AIHA. Management and outcome of these cases are discussed. An 88-year-old, patient was admitted with low Hb and raised bilirubin. He was already on steroids 15 mg daily for joint pain. In view of the strong red cell agglutination in the blood film (CHAD) was suspected initially and were investigated to exclude the secondary causes of CHAD. Three days later Hb dropped to 6.6 g dL−1. Samples were forwarded to the reference laboratory. The DAT was positive with IgG, IgM and C3d. Serological evidence of mixed-AIHA was confirmed at the reference laboratory. In view of the ongoing haemolysis, steroids were increased to 40 mg daily, and transfusion was given, together with intravenous immunoglobulin (IVIg). Haemolysis ceased and the patient was discharged on decreasing doses of steroid. This case was unusual as the patient developed AIHA while on steroids medication. An 85-year-old patient, was admitted with Hb level of 5.7 g dL−1 and evidence of haemolysis. Laboratory investigation confirmed mixed-type AIHA. A CT scan showed splenomegaly, with small volume lympadenopathy, which were too small to biopsy. A bone marrow biopsy showed no evidence of lymphoma infiltration. The patient was treated with steroids, IVIg, followed by chemotherapy (cyclophosphamide, vincrestine and steroids) with no response. Rituximab (357 mg m−2 weekly for 2 weeks) resulted in no response. The patient received 33 units of red cells over a 9 week period. She underwent splenectomy with resolution of haemolysis and Hb sustained at 11 g dL−1. Splenic biopsy revealed T cell angioimmunoblastic Non-Hodgkins lymphoma. Splenectomy should be considered in resistant mixed-type AIHA. |
| Databáze: | OpenAIRE |
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