Role of therapeutic plasma exchanges in refractory severe warm autoimmune hemolytic anemia: Presentation of two case reports.
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| Abstract | BACKGROUND: Warm autoimmune hemolytic anemia (WAIHA) is a disorder with a usually good response to corticosteroid treatment, whereas in some cases first-line treatment's response is poor and other therapies such as intravenous immunoglobulins (IVIGs), rituximab, or splenectomy must be applied. STUDY DESIGN AND METHODS: Herein, we describe two patients with severe WAIHA treated at our center, who obtained a response after therapeutic plasma exchanges (TPEs) combined with low doses of IVIG. RESULTS: The first patient was an 18-year-old man with no relevant past medical history who was diagnosed with WAIHA. The patient presented a progressive clinical worsening despite treatment with prednisone, IVIG, and rituximab. After starting TPEs, signs of hemolysis rapidly improved and hemoglobin started to recover. The second patient was a 38-year-old man with a past history of immune thrombocytopenia and WAIHA. The patient presented a new flare of WAIHA, with no response after 2 weeks of treatment with corticosteroids, IVIG, and rituximab. After initiation of TPEs, the patient had an improvement in hemolysis biomarkers and recovery of hemoglobin concentration. CONCLUSION: Combination of TPEs with rituximab and IVIG might be considered as a therapeutic option in patients with severe WAIHA without response to corticosteroid and IVIG treatment.
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| Authors | Irene García-García, Joan Cid, Alicia Palomino, Eva Giné, Alberto Alvarez-Larrán, María T Cibeira, Miquel Lozano |
| Journal | Transfusion (Transfusion) Vol. 60 Issue 11 Pg. 2753-2757 (11 2020) ISSN: 1537-2995 [Electronic] United States |
| PMID | 33089904 (Publication Type: Case Reports) |
| Copyright | © 2020 AABB. |
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