Korean J Hematol.  2006 Dec;41(4):317-320. 10.5045/kjh.2006.41.4.317.

Autoimmune Hemolytic Anemia in Myelodysplastic Syndrome

• Shim KY
• Roh MO
• Kim HJ
• Bae SB
• Kim CK
• Lee KT
• Lee YK
• Park SK
• Won JH
• Park HS
• Hong DS

• KMID: 2305221
• DOI: http://doi.org/10.5045/kjh.2006.41.4.317

Abstract

Autoimmune paraneoplastic syndromes are encountered in patients with myelodysplastic syndromes. A review of case reports suggested 10% of myelodysplastic syndrome patients may experience various autoimmune syndromes, associated with immunological-mediated hematologic abnormalities, such as Coombs' negative hemolytic anemia. In patients with myelodysplastic syndrome, Coombs' negative hemolytic anemia may be underdiagnosed due to its association with reticulocytopenia. Therefore, the findings from a peripheral blood smear and measurement of haptoglobin level are important. Autoimmune manifestations respond to immunosuppressive agents, including steroids. Herein, a case with Coombs' negative hemolytic anemia, diagnosed with myelodysplastic syndrome from a bone marrow biopsy, is reported, with a review of the previously reported literature.

Keyword

Myelodysplastic syndrome; Autoimmune; Hemolytic anemia

MeSH Terms

Anemia, Hemolytic
Anemia, Hemolytic, Autoimmune*
Biopsy
Bone Marrow
Haptoglobins
Humans
Immunosuppressive Agents
Myelodysplastic Syndromes*
Paraneoplastic Syndromes
Steroids
Haptoglobins
Immunosuppressive Agents
Steroids

Figure

• 

  Fig. 1 Spherocytosis, polychromasia and circulating nucleated red cell are shown on peripheral blood smear (Wright-Giemsa stain, ×1,000).

• 

  Fig. 2 Erythroid cells are increased and show dyserythropoietic features such as open chromatin pattern and nuclear budding (Wright-Giemsa stain, ×1,000).

Reference

1). Van Rhee F., Abela M. Coombs negative haemolytic anaemia responding to intravenous immunoglobulins in a patients with myelodysplastic syndrome. Clin Lab Haematol. 1991. 13:99–101.

2). Tamura S., Konya H., Miyazaki E, et al. Coombs negative autoimmune hemolytic anemia in a patient with myelodysplastic syndrome. Rinsho Ketsueki. 1991. 32:132–6.

3). Bennett JM., Catovsky D., Daniel MT, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982. 51:189–99.

4). Harris NL., Jaffe ES., Diebold J, et al. World Health Organization Classification of neoplastic disease of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting - Airlie House, Virginia, November 1997. J Clin Oncol. 1999. 17:3835–49.

5). Enright H., Jacob HS., Vercellotti G., Howe R., Belzer M., Miller W. Paraneoplastic autoimmune phenomena in patients with myelodysplastic syndromes: response to immunosuppressive therapy. Br J Hae-matol. 1995. 91:403–8.

6). Saif MW., Hopkins JL., Gore SD. Autoimmune phenomena in patients with myelodysplastic syndromes and chronic myelomonocytic leukemia. Leuk Lymphoma. 2002. 43:2083–92.

7). Sokol RJ., Hewitt S., Booker DJ. Erythrocyte autoantibodies, autoimmune haemolysis, and Myelodysplastic Syndromes. J Clin Pathol. 1989. 42:1088–91.

8). Bagby GC Jr., Gabourel JD., Linman JW. Glucocorticoid therapy in the preleukemic syndrome (hemopoietic dysplasia): identification of responsive patients by in-vitro techniques. Ann Intern Med. 1980. 92:55–8.