Autoimmune hemolytic anemia in cancer disorders

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Journal Article

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Autoimmune Hemolytic Anemia (AIHA): Symptoms, Diagnosis and Treatment


© 2016 Nova Science Publishers, Inc. Autoimmune hemolytic anemia (AIHA) results from auto-antibody mediated, uncompensated consumption of red blood corpuscle. AIHA is either idiopathic (primary) or secondary to other disorders. Secondary AIHA in cancer patients is drug induced or cancer cell induced, or may occur as part of paraneoplastic syndrome. AIHA phenomenon has been described in patients with hematological malignancies. In patients with chronic lymphocytic leukemia, and patients with Waldenstrom macroglobulinemia, an incidence of 5-15% and 10-20%, respectively, is noted. AIHA has been reported to a lesser extent with other malignant lymphomas, B-cell lymphocytic leukemia, and multiple myeloma. AIHA is much rarer with solid tumors such as ovarian malignancies, renal neoplasms, and Kaposi sarcoma. Furthermore, drug-induced AIHA has been reported with certain chemotherapeutic agents such as oxaliplatin. Cancer-associated AIHA is mostly direct Coombs’ positive, and to a lesser extent, cancer-associated AIHA can be either positive for both direct and indirect Coombs’ tests, or Coombs’ negative. Coombs’ positivity is associated with wide variability of the type of antibodies/hemolytic factors. The underlying mechanisms for the AIHA are correlated to either the paraneoplastic disorder or immune dysregulation. Although treatment of cancer-associated AIHA depends upon the associated malignancy, all treatments focus on better control of the underlying malignancy. Some treatments include steroids, rituximab, or cyclosporine.

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