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Rare Case of Autoimmune Hemolytic Anemia in a Patient With CML

By: Anna Nowogrodzki
Posted: Wednesday, December 19, 2018

Although autoimmune hemolytic anemia is generally rare in patients with hematologic malignancies, cold agglutinin disease should be considered in patients with chronic myeloid leukemia (CML) who have a rapid and severe fall in hemoglobin count. Based on a report in the Indian Journal of Hematology and Blood Transfusion, Anita Chopra, MD, of the All India Institute of Medical Sciences, New Delhi, and colleagues shared their clinical experience with a female patient whose rapid-onset anemia during therapy for CML was caused by red cell agglutination during a blast phase.

“Strikingly and unexpectedly,” the authors wrote, when they examined the patient’s blood under low-powered microscopy and found “conspicuous agglutination of red cells.” The confluence of both CML and red cell agglutination in a patient is “a very rare co-occurrence,” they added.

The 43-year-old patient had Philadelphia chromosome–positive CML for 15 years. She experienced rapid-onset anemia during a blast phase, displaying symptoms including aches, low fever, and pedal edema. In a month, her hemoglobin count declined from 146 g/L to 37 g/L. Usually, rapid onset of anemia in a patient receiving therapy for CML suggests disease acceleration. In this case, however, examination of a peripheral blood smear revealed red cell agglutination, possibly caused by cold agglutinin disease, a rare type of autoimmune hemolytic anemia, although the authors were not able to test for cold agglutinins.

The blast crisis was lymphoid, although Dr. Chopra and colleagues cautioned that with just a single patient’s case, it is not possible to determine whether this had an effect. Providers should consider that red cell agglutination is a possible, although rare, cause of anemia in patients with CML, the authors advised.



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