Olcay Lale, Koç Ahmet
Ankara Oncology Hospital, Demetevler, Ankara, Turkey.
Pediatr Hematol Oncol. 2005 Apr-May;22(3):207-13. doi: 10.1080/08880010590921478.
A 5-year-old girl developed acute lymphoblastic leukemia (T-ALL) 15 months after being diagnosed with autoimmune hemolytic anemia (AHA), while AHA was in partial remission. AHA was mediated by warm antibodies. Because AHA could not be controlled during the induction therapy of ALL, she was administered immunoglobulin G and plasmapheresis was performed. Hepatomegaly dissappeared in the 4th month. However, anemia requiring blood transfusion, positive direct Coombs' test, and splenomegaly dissappeared in the 13th month of the leukemia treatment; reticulocytosis and decreased haptoglobin level persisted. AHA exacerbated in the 24th month of the ALL therapy. Prednisolone was started but the family refused to continue the therapy. This case presents some features that were not reported before, such that ALL was preceded by AHA and involved T-cell lineage, AHA was mediated by warm antibodies, and the two disorders took place in childhood.
一名5岁女孩在被诊断为自身免疫性溶血性贫血（AHA）且处于部分缓解期15个月后，患上了急性淋巴细胞白血病（T-ALL）。AHA由温抗体介导。由于在ALL诱导治疗期间AHA无法得到控制，遂给予她免疫球蛋白G并进行了血浆置换。肝肿大在第4个月消失。然而，在白血病治疗的第13个月，需要输血的贫血、直接抗人球蛋白试验阳性及脾肿大消失；网织红细胞增多和触珠蛋白水平降低持续存在。在ALL治疗的第24个月，AHA病情加重。开始使用泼尼松龙，但家属拒绝继续治疗。该病例呈现出一些此前未报道过的特征，即ALL发生在AHA之后且累及T细胞系，AHA由温抗体介导，且这两种疾病均发生在儿童期。
