Abdulgabar Salama1, Dirk Hartnack2, Hans-Walter Lindemann3, Hans-Joachim Lange4, Mathias Rummel5, Andreas Loew6. 1. Institute of Transfusion Medicine, Charité-Universitätsmedizin - Campus Virchow-Klinikum, Berlin, Germany. 2. Department for Internal Medicine / Hematology and Oncology. Evangelisches Krankenhaus Wesel, Wesel, Germany. 3. Clinic for Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany. 4. Gemeinschaftspraxis und Tagesklinik für Hämatologie und Internistische Onkologie, Stralsund, Germany. 5. Department of Hematology-Oncology, University Hospital Gießen and Marburg, Gießen Campus, Gießen, Germany. 6. Clinic for Hematology and Oncology, Charité-Universitätsmedizin - Campus Virchow-Klinikum, Berlin, Germany.
Abstract
BACKGROUND: Many patients with autoimmune hemolytic anemia (AIHA) do not respond to standard therapy and/or may develop severe complications which can be of fatal outcome. There is some evidence that erythropoiesis-stimulating agents (ESAs) may be helpful in the management of such patients. METHODS: We describe the effect of ESAs in 12 new patients with therapy-refractory AIHA (7 of warm type and 5 of cold type) and review 5 previously reported cases. Serological testing was performed using standard methods. RESULTS: All patients responded well to treatment with ESAs. At least 5 of the 17 patients demonstrated complete recovery, and none of the patients developed significant adverse reactions due to treatment with ESAs. CONCLUSION: The mechanism by which ESAs improves hemolysis in AIHA is not completely clear. In addition to increased production and prolonged RBC survival, it may inhibit eryptosis (programmed cell death). ESAs represent a new option in the treatment of decompensated and/or refractory AIHA of warm and cold type. However, more information is required to assess which patients can be treated with ESAs.
BACKGROUND: Many patients with autoimmune hemolytic anemia (AIHA) do not respond to standard therapy and/or may develop severe complications which can be of fatal outcome. There is some evidence that erythropoiesis-stimulating agents (ESAs) may be helpful in the management of such patients. METHODS: We describe the effect of ESAs in 12 new patients with therapy-refractory AIHA (7 of warm type and 5 of cold type) and review 5 previously reported cases. Serological testing was performed using standard methods. RESULTS: All patients responded well to treatment with ESAs. At least 5 of the 17 patients demonstrated complete recovery, and none of the patients developed significant adverse reactions due to treatment with ESAs. CONCLUSION: The mechanism by which ESAs improves hemolysis in AIHA is not completely clear. In addition to increased production and prolonged RBC survival, it may inhibit eryptosis (programmed cell death). ESAs represent a new option in the treatment of decompensated and/or refractory AIHA of warm and cold type. However, more information is required to assess which patients can be treated with ESAs.
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