Reversal of autoimmune hemolytic anemia associated with chronic lymphocytic leukemia following high-dose immunoglobulin

An 85-year-old man with chronic lymphocytic leukemia developed severe warm antibody-type autoimmune hemolytic anemia. Initial therapy with high-dose corticosteroids had no discernible effect on the hemolytic process. Following treatment with high-dose intravenous immunoglobulin (0.4 g/kg/d for 5 consecutive days) there was an immediate and sustained increase in hematocrit accompanied by a progressive decline in reticulocyte count. A review of the literature reveals that some patients with steroid-resistant immune hemolysis may benefit from high-dose immunoglobulin. This approach should be considered in elderly patients with severe anemia whose medical status precludes splenectomy.