Risk of Autoimmune Hemolytic Anemia relapse after Stem Cell Transplantation


Autoimmune hemolytic anemia is a blood disorder where the body’s immune system produces proteins called antibodies that attack the surfaces of red blood cells causing them to rupture open.

This condition results in signs and symptoms of anemia such as skin pallor, fatigue, dizziness, an increased heart rate, and difficulty with breathing. The reason this occurs is that when the red blood cells rupture, hemoglobin is released into the bloodstream and the transport of oxygen to the tissues and organs needing this essential gas is compromised. The presence of hemoglobin in the bloodstream results in darkly colored urine when the blood is filtered through the kidneys. Bilirubin is also released into the bloodstream resulting in yellow discoloration of the eyes and/or skin (jaundice).1

Management

Autoimmune hemolytic anemia will be managed depending on the type of disease the patient has. This can be either the warm or cold types which are the secondary autoimmune hemolytic anemias that have certain risk factors and causes which trigger the diseases.

The warm type is the more common condition and is the less severe of the two. Managing the warm type is also easier than the cold type as the latter can be challenging to prevent and more difficult to manage effectively enough.

Warm type autoimmune hemolytic anemia is managed by attempting to suppress the immune system with intravenous steroid medications. If this therapy is ineffective, then stronger immunosuppressant medications such as rituximab are used to reduce the production of the anti-red cell antibodies. If these medications also don’t work, then surgical removal of the spleen (splenectomy) may be performed. With cold type autoimmune hemolytic anemia, patients are advised to avoid cold temperatures or to dress warmly if they cannot do so since the disorder is triggered by exposure to the cold. If this doesn’t work then administering stronger immunosuppressant drugs or performing a splenectomy is recommended.1

Some patients though may benefit from bone marrow or stem cell transplantation. This isn’t a viable option for everyone, but if the affected patient is fortunate enough to find a donor then the therapy is considered. Bone marrow or stem cell transplantation involves completely irradiating the patient’s immune system with radiation or chemotherapy so that the bone marrow and lymphatic system cannot produce any more abnormal antibodies. The patient is then given the donor stem cells intravenously and the ‘rebooted’ immune system can then start producing new and normal antibodies depending on the patient’s immunological needs.

Developing autoimmune hemolytic anemia after stem cell transplantation

Bone marrow or stem cell transplantation is a form of therapy for many blood-related disorders.

There have been anecdotal reports that those patients who received specific bone marrow transplants developed autoimmune hemolytic anemia following this therapy. This complication has been associated with younger patients who received cord blood transplantation. Clinicians and transplant doctors manage these patients with the medication cyclosporin to prevent the body from rejecting the bone marrow transplant and so that the immune system doesn’t start to produce antibodies against red blood cells.2

Of all the autoimmune conditions that can develop after bone marrow transplantation, autoimmune hemolytic anemia is the most commonly reported of these complications. Another condition that can also develop is immune thrombocytopenic purpura where the immune system produces antibodies that attack and damage the platelet cells in the bloodstream. If autoimmune hemolytic anemia and immune thrombocytopenic purpura develop together in the same patient, this is classified as Evan’s syndrome.3

Conclusion

Although the risk is there, there were a few limitations in the study that suggested autoimmune hemolytic anemia could occur as a result of the administration of stem cells. With that being said, retrospective studies may also miss patients who develop autoimmune hemolytic anemia after receiving the transplants so there is a bit of give-and-take with the potential cases.

In the end, it’s important to take note that autoimmune conditions can occur after such a treatment is initiated in these patients. Doctors are aware of these complications and that the appropriate and correct measures and therapies are put into place to try and prevent these issues from occurring.

It’s also important to make a note that patients who are critically ill and need these transplants should receive them when the benefits outweigh any potential risks of the therapy.

References

  1. https://rarediseases.org/rare-diseases/anemia-hemolytic-acquired-autoimmune/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120933/
  3. https://www.ncbi.nlm.nih.gov/pubmed/28654461

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