Exploring Protein A Immunoadsorption for Autoimmune Hemolytic Anemia with Hyper-IgG4emia

BACKGROUND Autoimmune hemolytic anemia (AIHA) is a hemolytic anemia characterized by autoantibodies against red blood cells. Patients with AIHA can have 4 subtypes of IgG-type red blood cell antibodies: IgG1, IgG2, IgG3, and IgG4. The development of this disease is closely related to IgG 1 and IgG 3, and the combination with high IgG4 is rare. A patient with autoimmune hemolytic anemia who had a poor response to the steroid combined with immunosuppressive regimen (methylprednisolone and cyclophosphamide) received 4 sessions of protein A immunosorbent therapy with good results and is still under continued follow-up. CASE REPORT A 60-year-old woman had recurrent dizziness, weakness, darkening of urine, and jaundice for 2 months. Five years ago, she underwent a lymph node biopsy for "pelvic lymph node enlargement", which indicated "reactive lymph node hyperplasia". Bone marrow aspiration indicated "myelodysplasia", excluding leukemia and plasma cell disease. This patient was first treated with the steroid combination immunosuppressive regimen (methylprednisolone and cyclophosphamide), but she had a poor outcome and an increase in progressive anemia. She was treated with methylprednisolone and cyclophosphamide combined with protein A immunoadsorption therapy. She responded well and her clinical symptoms improved after 2 weeks of treatment. Her malaise was significantly reduced, jaundice decreased, Hb rose to 76 g/L, and IgG4 decreased to 12.4 g/L. At the outpatient review after 2 months, the patient's clinical symptoms had disappeared, hemoglobin (Hb) increased to 136 g/L, and IgG4 decreased to 6.72 g/L. CONCLUSIONS Protein A immunosorbent therapy may be an effective treatment option for patients with AIHA who have a poor response to conventional therapy.