Oncology

Answer 2 Autoimmune hemolytic anemia. This case is most consistent with autoimmune hemolytic anemia, a known complication of CLL. The relatively rapid onset of symptoms and anemia, along with the presence of spherocytes on peripheral blood smear, are all consistent with autoimmune hemolysis. A direct Coombs test would establish the diagnosis. Prednisone is generally the initial therapy of choice. The anti-CD20 antibody, rituximab is an effective second-line therapy. Treatment of underlying CLL with chemotherapy is not necessary. Pure erythrocyte aplasia is a rare complication of CLL caused by the generation of autoantibodies against erythrocyte precursors. Unlike autoimmune hemolytic anemia, pure erythrocyte aplasia usually is indolent in onset. Idiopathic thrombocytopenic purpura is a complication of CLL but is unlikely in this case due to the minimal change in platelet count. Splenic sequestration is unlikely given the lack of a palpable spleen. Rapid progression of CLL is unlikely based upon the natural history of the disease, the lack of progressive lymphadenopathy, and the lack of thrombocytopenia. Click here to return to the questions

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