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Case Reports in Hematology
Volume 2016, Article ID 9181698, 3 pages
http://dx.doi.org/10.1155/2016/9181698
Case Report

Refractory IgG Warm Autoimmune Hemolytic Anemia Treated with Eculizumab: A Novel Application of Anticomplement Therapy

Department of Medicine, Division of Hematology, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Room E-725, Montreal, QC, Canada H3T 1E2

Received 30 September 2015; Accepted 9 March 2016

Academic Editor: Akimichi Ohsaka

Copyright © 2016 Kim Ma and Stephen Caplan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Warm autoimmune hemolytic anemia (wAIHA) is the most common form of AIHA, with corticosteroids in first-line treatment resulting in a 60–80% response rate. Atypical wAIHA and IgG plus complement mediated disease have a higher treatment failure rate and higher recurrence rate. We report a case of severe wAIHA secondary to Waldenström macroglobulinemia with life threatening intravascular hemolysis refractory to prednisone, rituximab, splenectomy, and plasmapheresis. A four-week treatment of eculizumab in this heavily pretreated patient resulted in a sustained increase in hemoglobin and transfusion independence, suggesting a role for complement inhibition in refractory wAIHA.