[Whole blood exchange for a critically ill patient with Hodgkin lymphoma complicated by severe autoimmune hemolytic anemia: a case report and literature review].

Abstract

This article reports the management of a patient with Hodgkin lymphoma (HL) complicated by refractory critical autoimmune hemolytic anemia (AIHA) and explores the value of whole blood exchange (WBE) after failure of conventional therapy and plasma exchange. The patient was a 52-year-old woman with a history of classical HL treated with anti-PD-1 therapy. She was admitted due to progressive fatigue and altered mental status, with a nadir hemoglobin level of 24 g/L and a positive direct antiglobulin test for both anti-immunoglobulin G and anti-C3d (1:256). She also presented with impaired consciousness and shock, leading to a diagnosis of critical AIHA. The patient failed to respond to multiple lines of treatment, including high-dose corticosteroids, intravenous immunoglobulin, rituximab, eculizumab, and plasma exchange, and experienced recurrent hypotension. After multidisciplinary consultation, WBE was performed. Within 24 hours after the procedure, her urine color turned from dark tea-colored to light yellow, with no recurrence of dark urine. The hemoglobin level increased to 52 g/L on day 5 and to 63 g/L on day 10 post-procedure. The lactate dehydrogenase level decreased from a peak level of 2 304 U/L to 481 U/L, and the total bilirubin level dropped to 20.4 μmol/L. The patient's hemodynamic status stabilized, and she was transferred out of the hematological intensive care unit on day 16. The present case demonstrates that for severe AIHA refractory to conventional immunosuppression and plasma exchange, WBE can rapidly remove sensitized erythrocytes and complement components, serving as an effective rescue therapy.