Chonnam Med J.  2008 Dec;44(3):184-187. 10.4068/cmj.2008.44.3.184.

Steroid-refractory Autoimmune Hemolytic Anemia Following Unrelated Allogeneic Peripheral Blood Stem Cell Transplantation

• Seo SR
• Kim YK
• Bae SY
• Yoon JY
• Lim SW
• Ahn JS
• Yang DH
• Cho SH
• Lee JJ
• Chung IJ
• Kim HJ

• KMID: 2172300
• DOI: http://doi.org/10.4068/cmj.2008.44.3.184

Abstract

A 29 years old female with chronic myelogenous leukemia underwent an unmanipulated, unrelated, HLA- matched peripheral blood stem cell transplantation (PBSCT) after imatinib mesylate treatment. The patient and donor had different ABO blood types and at 1 year later after PBSCT, the patient showed severe autoimmune hemolytic anemia (AIHA). She was treated with several immunosuppressive agents including high-dose steroid, cyclophosphamide, intravenous immunoglobulin and rituximab and underwent multiple sessions of plasma exchange. As her AIHA showed no response to these multiple therapies, she underwent splenic artery embolization and splenectomy. After then her AIHA was resolved with low dose oral steroid maintenance. Although the incidence of AIHA is known to be increased after allogeneic hematopoietic stem cell transplantation (HSCT), it has been rarely reported in Korea. Since AIHA in the setting of post-allogeneic HSCT is often difficult to treat and the prognosis is very poor, the accurate and early diagnosis is needed.

Keyword

Anemia, Hemolytic, Autoimmune; Peripheral blood stem cell transplantation; Leukemia, Myelogenous, Chronic

MeSH Terms

Anemia, Hemolytic, Autoimmune
Antibodies, Monoclonal, Murine-Derived
Benzamides
Cyclophosphamide
Early Diagnosis
Female
Hematopoietic Stem Cell Transplantation
Humans
Immunoglobulins
Immunosuppressive Agents
Incidence
Korea
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Mesylates
Peripheral Blood Stem Cell Transplantation
Piperazines
Plasma Exchange
Prognosis
Pyrimidines
Splenectomy
Splenic Artery
Tissue Donors
Imatinib Mesylate
Rituximab
Antibodies, Monoclonal, Murine-Derived
Benzamides
Cyclophosphamide
Immunoglobulins
Immunosuppressive Agents
Mesylates
Piperazines
Pyrimidines

Figure

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  Fig. 1 Peripheral blood smears at the time of diagnosis of autoimmune hemolytic anemia. (A) Representative photomicrograph (magnification, ×200) demonstrates marked anisocytosis with reticulocytosis. (B) There are many spherocytes (arrows) with leukoerythroblastosis representing severe hemolytic condition (magnification, ×400).

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