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Mixed‐Type Autoimmune Hemolytic Anemia following Fludarabine Treatment in a Patient with Chronic Lymphocytic Leukemia/Small Cell Lymphoma
Author(s) -
Vick Dan J.,
Byrd John C.,
Beal Connie L.,
Chaffin Donald J.
Publication year - 1998
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1046/j.1423-0410.1998.7420122.x
Subject(s) - fludarabine , chronic lymphocytic leukemia , autoimmune hemolytic anemia , medicine , immunology , anemia , autoantibody , lymphoma , leukemia , hemolytic anemia , gastroenterology , antibody , cyclophosphamide , chemotherapy
Background and objectives : Mixed‐type autoimmune hemolytic anemia (AIHA) is a rare complication of chronic lympocytic leukemia (CLL). We report a patient with small lymphocytic lymphoma (phenotypic CLL) who developed symptomatic anemia 3 weeks after her fifth cycle of fludarabine, a T cell immunosuppressant. Materials and methods : An antibody screen and panel, direct antiglobulin test, rapid acid eluate, rabbit erythrocyte stroma (RESt) adsorption, and autoadsorption were performed. Results : Warm and cold autoantibodies were detected. Prompt treatment with corticosteroids and minimal blood transfusions led to marked improvement. Conslusion : Normally, T cells suppress polyclonal lymphocytes that produce autoantibodies. Suppression of T cells in this patient, in addition to the underlying disease process, may explain this mixed‐type AIHA, the first reported case to occur following fludarabine treatment.