Erythropoietin May Improve Anemia in Patients with Autoimmune Hemolytic Anemia Associated with Reticulocytopenia

Abstract

Background: Management of patients with autoimmune hemolytic anemia (AIHA) and reticulocytopenia remains challenging. Case Reports: Two patients with decompensated AIHA who were receiving immunosuppressive drugs were treated with erythropoietin (EPO). Administration of EPO increased reticulocyte counts and hemoglobin concentrations in both cases. One patient completely recovered following a short course of treatment. Hemolysis could be compensated in the second patient using only mild doses of immunosuppressive drugs in combination with EPO. Conclusion: The administration of EPO should be considered in patients with therapyrefractory AIHA, particularly in the presence of reticulocytopenia.

Clinical heterogeneity and predictors of outcome in primary autoimmune hemolytic anemia: a GIMEMA study of 308 patients

“…1,2,42,43 Finally, we confirmed the utility of erythropoietin, particularly in the presence of reticulocytopenia, 44 suggesting that this drug may overcome the inadequate bone marrow compensation, as now established for thrombopoietin agonists in primary immune thrombocytopenia. 45 Altogether, our results showed that one-fourth of primary AIHA patients require at least 2 lines of therapy, about 13% require 3, and a small fraction (4%) require $4 lines; the most severe cases and the mixed and atypical forms had a 3-fold increased risk of relapse or unresponsiveness to therapy.…”

The Effect of Erythropoiesis-Stimulating Agents in Patients with Therapy-Refractory Autoimmune Hemolytic Anemia

“…Recently, we successfully treated 2 AIHA patients with ESAs and hypothesized that most AIHA patients may respond to this treatment [11]. This is clearly supported by the results obtained in the present study although it is limited by several drawbacks including the retrospective character, the heterogeneity of patients, the difference between treating physicians, the lack of a study protocol, and the lack of systematic measurement of natural ESA levels in treated patients.…”

“…A second explanation might be related to the decrease in the total amount of autoantibodies present on each RBC due to an increase in the total number of RBCs following ESA treatment [11]. …”

“…Thus, the need for alternative treatment options is highly evident. Recently, we have reported on two AIHA patients who have been successfully treated with erythropoiesis-stimulating agents (ESAs) [11]. Here, we describe the effect of ESAs in 7 new patients with therapy-refractory AIHA of the warm type (WAIHA) and 5 patients with chronic AIHA of the cold type (CAIHA).…”

Immune Hemolysis: Diagnosis and Treatment Recommendations

“…39 Finally, EPO has been successfully used in patients with therapy-refractory AIHA, and may be indicated particularly in the presence of reticulocytopenia. 4,40 As regards last option treatments for the few patients refractory to previous therapies, it is worth mentioning high dose cyclophosphamide (50 mg/kg/day for 4 days), 41 and alemtuzumab (particularly in CLL-associated AIHA), whose efficacy is anecdotical and needs further confirmatory studies. [42][43][44] The results reported in the literature about the efficacy of plasma-exchange are controversial, with favourable effects generally short-lived, so that it represents an "heroic or last-ditch efforts on behalf of a patient".…”