FATAL INTRAVASCULAR AUTOIMMUNE HEMOLYTIC-ANEMIA AFTER FLUDARABINE TREATMENT FOR CHRONIC - LYMPHOCYTIC-LEUKEMIA

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 treat ments including two courses of fludarabine. The direct antiglobulin te st (DAT) was negative at diagnosis but was found to be positive with a nti-IgG after the first fludarabine treatment. When the patient was tr eated again with fludarabine nine months later, the DAT became positiv e with anti-IgG and anti-C3d antiglobulins after the second course of treatment. Abrupt, fatal intravascular hemolysis occurred after the th ird course. The occurrence of severe AIHA in CLL patients treated with fludarabine has been reported by several authors. Physicians should b e aware of the risk of severe AIHA in CLL patients with a history of A IHA or positivation of the DAT during previous fludarabine administrat ion, or in case of secondary fixation of complement to the red cell me mbrane occurring during fludarabine treatment.