MIXED-TYPE AUTOIMMUNE HEMOLYTIC-ANEMIA FOLLOWING FLUDARABINE TREATMENT IN A PATIENT WITH CHRONIC LYMPHOCYTIC-LEUKEMIA SMALL-CELL LYMPHOMA

Background and objectives: Mixed-type autoimmune hemolytic anemia (AI- HA) is a rare complication of chronic lymphocytic leukemia (CLL), We r eport a patient with small lymphocytic lymphoma (phenotypic CLL) who d eveloped symptomatic anemia 3 weeks after her fifth cycle of fludarabi ne, a T cell immunosuppressant. Materials and Methods: An antibody scr een and panel, direct antiglobulin test, rapid acid eluate, rabbit ery throcyte stroma (RESt) adsorption, and autoadsorption were performed. Results: Warm and cold autoantibodies were detected. Prompt treatment with corticosteroids and minimal blood transfusions led to marked impr ovement. Conclusion: Normally, T cells suppress polyclonal lymphocytes that produce autoantibodies. Suppression of T cells in this patient i n addition to the underlying disease process, may explain this mixed-t ype AIHA, the first reported case to occur following fludarabine treat ment.