Li Bi-Juan, Yuan Xi, Jiang Yuan-Jun, Shu Xiang-Wu, Liu Kai-Liang
Blood Transfusion Department, Xiangya Hospital, Central South University, Changsha, China.
Transfusion. 2015 Sep;55(9):2231-7. doi: 10.1111/trf.13122. Epub 2015 Apr 24.
Autoimmune hemolytic anemia (AIHA) results from the excessive destruction of red blood cells (RBCs). Nowadays, there is no exact treatment for severe AIHA and our current medical therapies do not effectively stop the progression of severe AIHA. Therapeutic plasma exchange (TPE) is used as emergency therapy that is sometimes helpful. Whole blood exchange (WBE) is based on TPE while its replacement liquids are donor RBCs and fresh plasma. We hypothesized that WBE transfusion might be able to control the process of acute hemolysis, avoid the hemolytic crisis, and improve severe hemolytic anemic symptoms rapidly. The objective was to investigate the efficiency of WBE on severe AIHA.
Thirty severe AIHA patients were treated with WBE in our hospital from June 2003 to August 2013. An apheresis instrument (COBE Spectra, TerumoBCT) was employed in WBE procedure. We retrospectively analyzed the results of these severe anemic patients.
Twelve hours after WBE treatment, 26 of 30 (86.7%) patients' Hb levels were elevated immediately. Their total bilirubin concentration, direct bilirubin levels, and titers of antibodies were decreased, and clinical symptoms were relieved rapidly. Two (6.7%) patients' hemolysis was stopped from deteriorating, one (3.3%) patient's hemolysis was not controlled by the treatment due to malignancy, and another (3.3%) patient died from pleural hemorrhage of Evans syndrome.
This study suggests that WBE is an effective therapy for severe AIHA. Further investigation of this application is warranted.
自身免疫性溶血性贫血（AIHA）是由红细胞（RBC）过度破坏引起的。目前，对于严重AIHA尚无确切的治疗方法，我们现有的医学疗法无法有效阻止严重AIHA的进展。治疗性血浆置换（TPE）作为一种紧急疗法，有时会有所帮助。全血置换（WBE）基于TPE，但其置换液为供体红细胞和新鲜血浆。我们推测WBE输血可能能够控制急性溶血过程，避免溶血危机，并迅速改善严重溶血性贫血症状。目的是研究WBE对严重AIHA的疗效。
2003年6月至2013年8月，我院对30例严重AIHA患者进行了WBE治疗。WBE过程中使用了血液成分分离仪（COBE Spectra，TerumoBCT）。我们回顾性分析了这些严重贫血患者的治疗结果。
WBE治疗12小时后，30例患者中有26例（86.7%）的血红蛋白水平立即升高。他们的总胆红素浓度、直接胆红素水平和抗体滴度降低，临床症状迅速缓解。2例（6.7%）患者的溶血停止恶化，1例（3.3%）患者因恶性肿瘤导致溶血未得到控制，另1例（3.3%）患者死于Evans综合征的胸腔出血。
本研究表明WBE是治疗严重AIHA的有效疗法。有必要对该应用进行进一步研究。
