Complement-Dominant Relapse of Mixed Autoimmune Hemolytic Anemia After Rituximab Response.

IF 1.3

EJHaem Pub Date : 2026-08-23 eCollection Date: 2026-08-01 DOI:10.1002/jha2.70381

Naru Tomigaki, Seiji Kakiuchi, Akimasa Sakamoto, Shutaro Fujioka, Isamu Harima, Hiroaki Akiyama, Ryotaro Niwa, Ikumi Takagi, Yoko Kozuki, Yoshiharu Miyata, Sou Tanaka, Hiroyuki Tsuji, Nobuko Iwata

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Abstract

Introduction: Mixed autoimmune hemolytic anemia (AIHA) may show temporal shifts in its predominant effector mechanism.

Methods: We serially assessed clinical course, direct antiglobulin test (DAT) specificity, cold agglutinin activity, complement markers, marrow findings, and immunofixation after rituximab response.

Results: During winter relapse, the previously identified κ-restricted CD20-positive population was no longer detectable by marrow flow cytometry. Hemolysis was cold-reactive and complement-dominant. Hemoglobin increased without transfusion after sutimlimab, with C4 recovery and total hemolytic complement activity (CH50) suppression despite persistent cold agglutinin activity. Immunofixation later identified IgG-κ and IgM-κ monoclonal proteins.

Conclusions: Serial reassessment may identify complement-mediated relapse in mixed AIHA.

Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.

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利妥昔单抗反应后补体显性混合型自身免疫性溶血性贫血复发

导论：混合性自身免疫性溶血性贫血（AIHA）的主要作用机制可能表现出时间上的变化。方法：我们对临床病程、直接抗球蛋白试验（DAT）特异性、冷凝集素活性、补体标志物、骨髓结果和利妥昔单抗应答后的免疫固定进行了连续评估。结果：在冬季复发期间，骨髓流式细胞术不再检测到先前鉴定的κ-限制性cd20阳性人群。溶血以冷反应为主，补体为主。使用苏替利单抗后，血红蛋白在不输血的情况下增加，C4恢复和总溶血补体活性（CH50）抑制，尽管冷凝集素活性持续存在。免疫固定后鉴定IgG-κ和IgM-κ单克隆蛋白。结论：系列重新评估可识别补体介导的混合型AIHA复发。试验注册：作者已确认本次提交不需要临床试验注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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EJHaem

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