Successful Rituximab Treatment of Autoimmune Hemolytic Anemia Caused by Both Warm Autoantibodies and Cold Agglutinin: A Case Report
American Journal of Internal Medicine
Volume 3, Issue 4, July 2015, Pages: 156-159
Received: Feb. 28, 2015;
Accepted: Mar. 4, 2015;
Published: Jun. 23, 2015
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Motoharu Shibusawa, Department of Hematology Medicine, Tokyo Metropolitan Health and Medical Treatment Corporation, Tama-Hokubu Medical Center, Tokyo, Japan
Yoshirou Murai, Department of Hematology Medicine, Tokyo Metropolitan Health and Medical Treatment Corporation, Tama-Hokubu Medical Center, Tokyo, Japan
Hisashi Tsutsumi, Department of Hematology Medicine, Tokyo Metropolitan Health and Medical Treatment Corporation, Tama-Hokubu Medical Center, Tokyo, Japan
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This report describes a case which successfully treated with rituximab against autoimmune hemolytic anemia caused by both warm autoantibodies and cold agglutinin (mixed AIHA). A 52-year-old man with malaise was referred to our hospital in December 2002. A diagnosis of mixed AIHA was made. His clinical course showed that the hemolysis was mainly caused by cold agglutinin, with a possible contribution from the warm autoantibody. He was treated with prednisolone (PSL), Cyclosporine (CyA), and cyclophosphamide (CPA). The treatment with PSL, CyA, and CPA failed to stabilize the hemolysis caused by cold exposure in the winter season. In November 2013 (winter season), rituximab therapy (375 mg/m2 weekly for four weeks) was started, and the hemolysis improved. The present case suggests that rituximab is useful against mixed AIHA. Further studies are warranted to establish the effectiveness of rituximab against mixed AIHA.
Autoimmune Hemolytic Anemia, Rituximab, Mixed Autoimmune Hemolytic Anemia
To cite this article
Successful Rituximab Treatment of Autoimmune Hemolytic Anemia Caused by Both Warm Autoantibodies and Cold Agglutinin: A Case Report, American Journal of Internal Medicine.
Vol. 3, No. 4,
2015, pp. 156-159.
S. Bluml, K. McKeever, R. Ettinger, J. Smolen and R. Herbst. B-cell targeted therapeutics in clinical development. Arthritis Res Ther. 2013; 15 Suppl 1: S4.
K. Lechner and U. Jager. How I treat autoimmune hemolytic anemias in adults. Blood. 2010; 116(11): 1831-8.
G. Bussone, E. Ribeiro, A. Dechartres, J. F. Viallard, B. Bonnotte, O. Fain, B. Godeau and M. Michel. Efficacy and safety of rituximab in adults' warm antibody autoimmune haemolytic anemia: retrospective analysis of 27 cases. Am J Hematol. 2009; 84(3): 153-7.
S. Berentsen, E. Ulvestad, B. T. Gjertsen, H. Hjorth-Hansen, R. Langholm, H. Knutsen, W. Ghanima, F. V. Shammas and G. E. Tjonnfjord. Rituximab for primary chronic cold agglutinin disease: a prospective study of 37 courses of therapy in 27 patients. Blood. 2004; 103(8): 2925-8.
C. E. Brown, J. P. Traynor, R. A. Sharp and J. G. Fox. Successful treatment with rituximab of autoimmune haemolytic anaemia causing dialysis-dependent acute renal failure. Nephrol Dial Transplant. 2007; 22(9): 2730-1.
D. Webster, B. Ritchie and M. J. Mant. Prompt response to rituximab of severe hemolytic anemia with both cold and warm autoantibodies. Am J Hematol. 2004; 75(4): 258-9.
K. Ono, T. Sato, S. Iyama, A. Tatekoshi, A. Hashimoto, Y. Kamihara, H. Horiguchi, S. Kikuchi, K. Takada, T. Hayashi, K. Miyanishi, Y. Sato, R. Takimoto, M. Kobune and J. Kato. Successful treatment with rituximab in a patient with refractory mixed-type autoimmune hemolytic anemia [Japanese article]. Rinsho Ketsueki. 2013; 54(11): 2053-5.
S. Gupta, A. Szerszen, F. Nakhl, S. Varma, A. Gottesman, F. Forte and M. Dhar. Severe refractory autoimmune hemolytic anemia with both warm and cold autoantibodies that responded completely to a single cycle of rituximab: a case report. J Med Case Rep. 2011; 5: 156.
M. Morselli, M. Luppi, L. Potenza, S. Tonelli, D. Dini, G. Leonardi, A. Donelli, F. Narni and G. Torelli. Mixed warm and cold autoimmune hemolytic anemia: complete recovery after 2 courses of rituximab treatment. Blood. 2002; 99(9): 3478-9.