Vick D J, Byrd J C, Beal C L, Chaffin D J
Department of Pathology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Vox Sang. 1998;74(2):122-6.
Mixed-type autoimmune hemolytic anemia (AIHA) is a rare complication of chronic lymphocytic leukemia (CLL). We report a patient with small lymphocytic lymphoma (phenotypic CLL) who developed symptomatic anemia 3 weeks after her fifth cycle of fludarabine, a T cell immunosuppressant.
An antibody screen and panel, direct antiglobulin test, rapid acid eluate, rabbit erythrocyte stroma (RESt) adsorption, and autoadsorption were performed.
Warm and cold autoantibodies were detected. prompt treatment with corticosteroids and minimal blood transfusions led to marked improvement.
Normally, T cells suppress polyclonal lymphocytes that produce autoantibodies. Suppression of T cells in this patient, in addition to the underlying disease process, may explain this mixed-type AIHA, the first reported case to occur following fludarabine treatment.
混合型自身免疫性溶血性贫血（AIHA）是慢性淋巴细胞白血病（CLL）的一种罕见并发症。我们报告一名患有小淋巴细胞淋巴瘤（表型为CLL）的患者，在其接受第五周期氟达拉滨（一种T细胞免疫抑制剂）治疗3周后出现了症状性贫血。
进行了抗体筛查与鉴定、直接抗球蛋白试验、快速酸洗脱、兔红细胞基质（RESt）吸附及自身吸附试验。
检测到温抗体型和冷抗体型自身抗体。使用皮质类固醇进行及时治疗并尽量减少输血，病情显著改善。
正常情况下，T细胞会抑制产生自身抗体的多克隆淋巴细胞。该患者T细胞受到抑制，再加上潜在的疾病进程，可能解释了这种混合型AIHA，这是首例报道的氟达拉滨治疗后发生的病例。
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