Borja-Montes Oscar F, Toro-Pedroza Alejandro, Horton Darrell D, Andritsos Leslie A, Ebaid Ala
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA.
Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.
Eur J Case Rep Intern Med. 2024 Aug 14;11(9):004780. doi: 10.12890/2024_004780. eCollection 2024.
Warm autoimmune haemolytic anaemia (wAIHA) is an acquired haemolytic disorder most commonly treated with a combination of corticosteroids, rituximab and/or splenectomy. Third-line therapies for refractory cases include immunosuppressive agents. Mycophenolate mofetil is frequently used in these scenarios, although its use is supported by small studies and anecdotal evidence rather than large-scale data.
We describe three cases of refractory warm autoimmune haemolytic anaemia successfully treated with mycophenolate mofetil. Case 1: A persistent case of autoimmune haemolytic anaemia in a 56-year-old was ultimately managed with mycophenolate mofetil, leading to successful steroid tapering and stable haemoglobin levels without relapse. Case 2: A woman with a complex oncological history, including lymphoma and breast cancer, achieved remission with mycophenolate therapy, maintaining stability post-steroid treatment. Case 3: Mycophenolate proved effective for a 63-year-old with cirrhosis after recurrent autoimmune anaemia and deep vein thrombosis, enabling cessation of steroids and maintaining remission.
Management of this condition can be challenging and balancing the available treatments is crucial to reduce potential complications from long-term therapies that appear to be ineffective. Our case series demonstrates anecdotal experience on successful use of mycophenolate mofetil for complex refractory cases of wAIHA.
Warm autoimmune haemolytic anaemia can be a challenging condition to manage. Refractory cases that are steroid-dependent can benefit from trialling steroid-sparing agents such as mycophenolate.Anti-CD20 agents such as rituximab can be very effective in refractory cases, however there is a small percentage of patients that might not be responsive to this monoclonal antibody.Autoimmune haemolytic anaemias can be frequently complicated by thrombotic events, and part of the backbone treatment is establishing good thromboprophylaxis.
温抗体型自身免疫性溶血性贫血（wAIHA）是一种获得性溶血性疾病，最常用皮质类固醇、利妥昔单抗和/或脾切除术联合治疗。难治性病例的三线治疗包括免疫抑制剂。霉酚酸酯常用于这些情况，尽管其使用仅得到小型研究和轶事证据的支持，而非大规模数据。
我们描述了3例用霉酚酸酯成功治疗的难治性温抗体型自身免疫性溶血性贫血病例。病例1：一名56岁的持续性自身免疫性溶血性贫血患者最终用霉酚酸酯治疗，实现了成功减停类固醇，血红蛋白水平稳定且无复发。病例2：一名有复杂肿瘤病史（包括淋巴瘤和乳腺癌）的女性，通过霉酚酸酯治疗实现缓解，在类固醇治疗后保持稳定。病例3：霉酚酸酯对一名63岁复发性自身免疫性贫血和深静脉血栓形成后出现肝硬化的患者有效，使其能够停用类固醇并维持缓解。
这种疾病的管理具有挑战性，平衡可用治疗方法对于减少长期治疗无效带来的潜在并发症至关重要。我们的病例系列展示了霉酚酸酯成功用于wAIHA复杂难治性病例的轶事经验。
温抗体型自身免疫性溶血性贫血可能是一种具有挑战性的疾病。依赖类固醇的难治性病例可从试用如霉酚酸酯等类固醇节省药物中获益。抗CD20药物如利妥昔单抗在难治性病例中可能非常有效，然而有一小部分患者可能对这种单克隆抗体无反应。自身免疫性溶血性贫血常并发血栓事件，主要治疗措施之一是建立良好的血栓预防措施。
