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Efficacy of D– red blood cell transfusion and rituximab therapy in autoimmune hemolytic anemia with anti‐D and panreactive autoantibodies arising after hematopoietic stem cell transplant
Author(s) -
Minakawa Keiji,
Ohto Hitoshi,
Yasuda Hiroyasu,
Saito Shunichi,
Kawabata Kinuyo,
Ogawa Kazuei,
Nollet Kenneth E.,
Ikeda Kazuhiko
Publication year - 2018
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14634
Subject(s) - medicine , autoantibody , immunology , autoimmune hemolytic anemia , rituximab , hemolytic anemia , hematopoietic stem cell transplantation , anemia , antibody , transplantation
BACKGROUND Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies to red blood cells (RBCs), which can be panreactive and/or specific to Rh/other blood group antigens. We report a severe case of AIHA after bone marrow transplantation (BMT) due to autoanti‐D triggered by reactivation of Epstein‐Barr virus (EBV) infection. A combined strategy of D– RBC transfusion and administration of anti‐CD20 monoclonal antibody (MoAb) resolved the hemolysis. CASE REPORT A 33‐year‐old male underwent allogeneic BMT from an ABO‐identical and HLA‐matched unrelated male donor. Five months later, while having mild chronic graft‐versus‐host disease, he manifested AIHA, with a hemoglobin (Hb) level of 5.1 g/dL on AIHA Day 2 (Posttransplant Day 156) and was refractory to D+ RBCs, with a Hb level of 2.4 g/dL on AIHA Day 6. Anti‐D–like autoantibodies (titer 1280, subclass immunoglobulin G 1 , monocyte monolayer assay 28.7%) and panreactive (titer 40) were identified. Changing the RBC transfusion strategy to D– increased his Hb level to 6.7 g/dL on Day 10. Administration of anti‐CD20 MoAb mitigated EBV‐related B‐cell proliferation and reduced anti‐D autoantibody titer to 320 by Day 16 with normalized Hb concentration after 6 months. CONCLUSION In severe AIHA, when standard treatment and regular RBC transfusions are ineffective, transfusion of RBCs lacking the target antigen(s) of autoantibodies and administration of anti‐CD20 MoAb should be considered.