Mitchell C A, Van der Weyden M B, Firkin B G
Department of Medicine, Alfred Hospital, Vic.
Aust N Z J Med. 1987 Jun;17(3):290-4. doi: 10.1111/j.1445-5994.1987.tb01228.x.
Four patients with warm type autoimmune hemolytic anemia who failed to respond to steroid therapy received high dose intravenous gammaglobulin (0.2-0.4 g/kg daily) for five days. In one patient hemolysis occurred in association with non-Hodgkin's lymphoma and in the others the cause of the hemolysis was not established; two patients had prior splenectomy. A response to gammaglobulin therapy, demonstrable by a rise in or stabilisation of hemoglobin levels, a decrease in elevated serum bilirubin and lactate dehydrogenase levels, or prolongation of a shortened red cell (51Cr) survival, was observed in three patients. In two of these patients the effect of gammaglobulin therapy was temporary but allowed for splenectomy to proceed in one patient, without blood transfusion. The third patient continued to improve after cessation of gammaglobulin treatment. These findings suggest that high dose intravenous gammaglobulin may temporarily ameliorate hemolysis in some individuals with warm type immune hemolytic anemia, and may be a useful adjunct to steroids immediately before splenectomy.
4例对类固醇疗法无反应的温抗体型自身免疫性溶血性贫血患者接受了大剂量静脉注射丙种球蛋白治疗（每日0.2 - 0.4 g/kg），持续5天。1例患者的溶血与非霍奇金淋巴瘤相关，其他患者溶血原因未明确；2例患者曾行脾切除术。3例患者出现了对丙种球蛋白治疗的反应，表现为血红蛋白水平升高或稳定、血清胆红素和乳酸脱氢酶水平降低，或红细胞（51Cr）生存时间延长。其中2例患者丙种球蛋白治疗的效果是暂时的，但使1例患者能够在不输注血液的情况下进行脾切除术。第3例患者在停止丙种球蛋白治疗后持续改善。这些发现表明，大剂量静脉注射丙种球蛋白可能会暂时改善某些温抗体型免疫性溶血性贫血患者的溶血情况，并且在脾切除术之前可能是类固醇的有用辅助药物。
