Autoimmune Haemolytic Anaemia in Patients with Cancer Diagnoses

Abstract

Aims: To determine if AIHA plays a role in anaemia associated with malignancies, and ascertain the cancers in which AIHA occurs. Study Design: This was a cross-sectional case-control study. Place and Duration of Study: Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Rivers, Nigeria. Methodology: We conducted the study on patients with malignancies either on admission in the wards or attending follow up clinics. Healthy age/sex-matched subjects were used as controls. Cases with and without chemotherapy were analyzed as subgroups. Three hundred and seventy-six (376) participants (188 cancer patients and 188 controls) were enrolled in the study. Full blood count, reticulocyte count, blood film, direct antiglobulin test (DAT), indirect antiglobulin test (IAT) and bilirubin assays were conducted on anticoagulated blood samples of all the patients and controls. The DAT was performed on a fresh sample not more than 6 hours after collection using polyspecific anti-human globulin. Results: Three (1.6%) of the 188 patients with malignancies were found to have a positive DAT of which 2 (1.1%) had strongly positive DAT with features of haemolysis and therefore had AIHA. The two patients with AIHA had chronic lymphocytic leukaemia. The third case was a weak positive DAT with malignant teratoma but did not have features of haemolysis. The cases of both AIHA and DAT were found in the group without chemotherapy. AIHA was the aetiology of anaemia in 2 (2%) of the 98 cases who had anaemia and were chemotherapy naive. Conclusion: AIHA plays a minor role in the aetiology of anaemia in cancer and is more common in lymphoid malignancies. A positive DAT may occur without features of haemolysis.