Tertian G, Cartron J, Bayle C, Rudent A, Lambert T, Tchernia G
Laboratoire d'Hématologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Hematol Cell Ther. 1996 Aug;38(4):359-60. doi: 10.1007/s00282-996-0359-3.
We report the case of a patient with chronic lymphocytic leukemia (CLL) who developed fatal intravascular autoimmune hemolytic anemia (AIHA) after fludarabine treatment. He had previously received several treatments including two courses of fludarabine. The direct antiglobulin test (DAT) was negative at diagnosis but was found to be positive with anti-IgG after the first fludarabine treatment. When the patient was treated again with fludarabine nine months later, the DAT became positive with anti-IgG and anti-C3d antiglobulins after the second course of treatment. Abrupt, fatal intravascular hemolysis occurred after the third course. The occurrence of severe AIHA in CLL patients treated with fludarabine has been reported by several authors. Physicians should be aware of the risk of severe AIHA in CLL patients with a history of AIHA or positivation of the DAT during previous fludarabine administration, or in case of secondary fixation of complement to the red cell membrane occurring during fludarabine treatment.
我们报告了一例慢性淋巴细胞白血病（CLL）患者，其在接受氟达拉滨治疗后发生了致命的血管内自身免疫性溶血性贫血（AIHA）。他此前接受过包括两个疗程氟达拉滨在内的多种治疗。诊断时直接抗球蛋白试验（DAT）为阴性，但在首次氟达拉滨治疗后发现抗IgG呈阳性。九个月后患者再次接受氟达拉滨治疗，第二个疗程后DAT抗IgG和抗C3d抗球蛋白均呈阳性。第三个疗程后发生了突发的致命性血管内溶血。多位作者报告了氟达拉滨治疗的CLL患者中发生严重AIHA的情况。医生应意识到，有AIHA病史或既往氟达拉滨给药期间DAT呈阳性的CLL患者，或氟达拉滨治疗期间发生补体继发性固定于红细胞膜的情况下，发生严重AIHA的风险。
