Successful Treatment of Refractory Autoimmune Haemolytic Anaemia by Plasmapheresis

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Abstract
A 16 yr old female was admitted because of rapidly progressive fatigue, severe anemia and icterus. The S-bilirubin was 190 .mu.mol/l, COHb 7.3% and high amounts of free Hb in plasma were present. The Coombs'' direct test was strongly positive with anti-IgG, but negative with anti-IgM and anti-C3 complement. Conventional therapy with very high doses of hydrocortisone i.v., cyclophosphamide, azathioprine and transfusions of washed packed red cells proved ineffective. During 5 consecutive days she also received i.v. infusions of .gamma. globulin (25 g each day). Nevertheless, her condition deteriorated and 3 plasma exchanges were carried out with impressive clinical and laboratory effects. After the 3rd plasma exchange, the patient did not require further transfusions of packed red cells. Therapy with corticosteroids could be rapidly reduced and she was discharged after 5 wk with a normal blood picture. Since then she has remained in excellent health.