Anemia hemolítica autoinmune refractaria a tratamiento de primera línea. Un reto hematológico. Reporte de caso.

Abstract

Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies, cold (IgM), hot (IgG) or others, directed against the erythrocyte, causing its lysis. Sometimes this pathology progresses torpidly and is refractory to treatment, requiring interventions beyond corticosteroids, such as therapy with immunoglobulins, immunosuppressants, splenectomy or even the use of anti-CD20 monoclonal antibody. We present the case of an infant diagnosed with AIHA with a poor response to first-line treatment based on steroids and immunoglobulins, even requiring a splenectomy, with a subsequent partial response, so it was decided to administer anti-CD20 monoclonal antibody for four weeks and immunosuppression with azathioprine, thereby achieving an increase in his hemoglobin, remaining asymptomatic until discharge from the hospital. Second- and third-line treatment are an effective but not risk-free alternative for those patients refractory to conventional treatment.