Hemolytic anemia is a disease caused by
autoantibodies and resulting in various complaints and clinical symptoms. In about half of cases, the cause of
autoimmune hemolytic anemia can not be determined.
Corticosteroids are the first-line treatment option for warm
autoantibody-related
hemolytic anemia. In patients who develop
steroid side effects or do not respond adequately, other immunosuppressives may be preferred. In case a rapid response is required or fulminant
hemolysis occur, human
immunoglobulins (IVIGs) may be added to treatment. Finally,
plasma exchange (PE) may additionally be utilised. The essence of PE is based on the removal of
immune complexes,
protein-bound toxins,
autoantibodies and high molecular weight solutes and
protein-bound solutes. The main clinical aim of the removal of solutes is usually to gain a faster response than immunosuppressive therapy. Studies related to
hemolytic anemia and PE are usually based on case reports. Our case report is about a patient with severe
IgG subtype
hemolytic anemia. The treatment was started with 1 mg/kg
methylprednisolone; to which there was no response with weekly
rituximab 375 mg/m2 and
IVIG administered. Because of unresponsiveness to all of the immunosuppresives, a total of 5 sessions of PE were added to the treatment procedure every other day. After these sessions, the requirement for transfusions has decreased and the patient underwent
splenectomy. The patient is currently being followed up only on oral
cyclosporine and the last
hemoglobin level was 14.7 g /dl. In severe and
refractory anemia, especially in the case of cardiovascular imbalance in fulminant
hemolysis, PE may be preferred as a third series option after immunosuppressive treatments and play a role as a bridge to
splenectomy.