ABCL-226: Triple Whammy Hemolytic Anemia: Malaria, Cold and Warm Antibody

Abstract

Introduction Autoimmune hemolytic anemias (AIHAs) are a group of disorders with warm-, cold-, or mixed-reactive antibodies against the red blood cell surface. AIHA is a disorder of hyperfunctioning B lymphocytes associated with immune-related disorders, infections, and other lymphoproliferative disorders. We describe a case of both warm and cold hemolytic anemia associated with diffuse large B cell lymphoma (DLBCL). Case Report A 47-year-old gentleman from Liberia initially presented in October 2014 with severe fatigue. Evaluation revealed pelvic lymph node enlargement, hemoglobin 3.5 g/dl, indirect bilirubin 1.6 mg/dl, and haptoglobin Discussion Immune-mediated hemolytic anemia is a rare cause of anemia in DLBCL. More than 80% of cases are due to warm antibodies, and the incidence of cold antibodies is even rarer. In our case, initially, IgG warm antibodies and C3d cold antibodies were present; over time, IgG disappeared, and C3d persisted. He also had hemolysis secondary to Plasmodium reactivation. Although hemolysis was initially responsive to rituximab monotherapy, upon lymphoma recurrence, treatment with BR regimen resulted in simultaneous lymphoma remission and hemolysis control. Non-immune causes of hemolytic anemia and the recurrence of lymphoma should be considered in patients in whom hemolysis persists after treatment.