Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Severe refractory autoimmune hemolytic anemia with both warm and cold autoantibodies that responded completely to a single cycle of rituximab: a case report. | Gupta et al. Journal of Medical Case Reports 2011 5 156 http content 5 1 156 JOURNALOF medical Ur Case REPORTS CASE REPORT Open Access Severe refractory autoimmune hemolytic anemia with both warm and cold autoantibodies that responded completely to a single cycle of rituximab a case report 1 2 1 1 31 1 Shilpi Gupta Anita Szerszen Fadi Nakhl Seema Varma Aaron Gottesman Frank Forte and Meekoo Dhar Abstract Introduction Mixed warm and cold autoimmune hemolytic anemia runs a chronic course with severe intermittent exacerbations. Therapeutic options for the treatment of hemolysis associated with autoimmune hemolytic anemia are limited. There have been only two reported cases of the effective use of rituximab in the treatment of patients with mixed autoimmune hemolytic anemia. We report a case of severe mixed autoimmune hemolytic anemia that did not respond to steroids and responded to four weekly doses of rituximab one cycle . Case presentation A 62-year-old Caucasian man presented with dyspnea jaundice and splenomegaly. His blood work revealed severe anemia hemoglobin g dL with biochemical evidence of hemolysis. Exposure to cold led to worsening of the patient s hemolysis and hemoglobinuria. A direct antiglobulin test was positive for immunoglobulin G and complement C3d and cold agglutinins of immunoglobulin M type were detected. A bone marrow biopsy revealed erythroid hyperplasia. A positron emission tomographic scan showed no sites of pathologic uptake. There was no other evidence of a lymphoid or myeloid disorder. Initial therapy consisted of avoidance of cold intravenous methylprednisolone and a trial of plasmapheresis. However there was no clinically significant response and the patient continued to be transfusion-dependent. He was then started on 375 mg m2 week intravenous rituximab therapy. After two treatments his hemoglobin stabilized and the transfusion requirement diminished. Rituximab was continued for a total of four weeks .
