Part 1: Autoimmune Hemolytic Anemia

Thomas G. DeLoughery, MD

Professor of Medicine, Pathology, and Pediatrics, Division of Hematology/Medical Oncology,
Departments of Medicine and Pediatrics, and Division of Laboratory Medicine, Department of
Pathology, Oregon Health Sciences University, Portland, OR

Question 1

You are called to consult on a patient with end-stage liver disease and anemia. His hematocrit is 25%. He is noted to have a direct antibody test (DAT) that is positive for IgG antibodies but negative for C3. He has a normal lactate dehydrogenase (LDH) level at 185 U/L and a normal reticulocyte count. What is the next step in the management of this patient??

  •   Consult surgery about splenectomy
  •   Order measurement of ferritin level and additional laboratory tests
    plus review blood smear looking for other causes of anemia
  •   Start mycophenolate 500 to 1000 mg twice daily
  •   Start prednisone at 1 mg/kg/day
  •   Start rituximab at 375 mg/m2 weekly × 4 weeks

Updated 05/24/2013 • jdw | Copyright ©2014 Turner White Communications