Autoimmune Hemolisis in the Patients with B-Cell Non-Hodgkin Lymphomas

Autoimmune hemolytic anemia (AIHA) can complicate B-cell non-Hodgkin's lymphomas. It can develop as a consequence of the oncological process and may be a complication of drug therapy. Hemolysis is able to inhibit the C1q component of complement and affect the effectiveness of rituxim therapy. The purpose of the study was to determine the frequency of autoimmune anti-erythrocyte antibodies and laboratory signs of hemolysis (levels of free hemoglobin, haptoglobin and indirect bilirubin) in patients with B-NHL, depending on the stage of the disease and the regimen of therapy. Materials and methods. 57 patients with B-NHL were divided into 3 groups. The group I included those who did not receive specific therapy, group II – who received CHOP, CHOEP, COP or FC, group III – R-CHOP, R-CHOEP, R-COP, R-FC. Anti-erythrocyte autoimmune antibodies, levels of free hemoglobin (fHb), haptoglobin (Hp), indirect bilirubin were tested in patients' venous blood. Elevated level of fHb and reduced of Hp are markers of intravascular hemolysis, and elevated levels of indirect bilirubin is marker of extravascular one. Results and discussion. Antibodies were detected in 42.9% of patients of group II. IgG / C3 were detected in 28,6% of ones, cold agglutinin – 7,1%, acidic haemolysins – 21.4%, C3d and / or C3c – 14.3%. Antibodies were found in 12.9% of the patients of group III: IgG – 3,2%, acid haemolysins – 6,4%, C3d and / or C3c – 3,2% (many patients showed several serological types). In I group antibodies were detected in 16,7% (IgG – 8,3%, acid haemolysins also in 8,3%). Laboratory signs of intra- and extravascular hemolysis and decreased hemoglobin levels were found in the vast majority of patients of group II. Patients of group I and group III had signs of extravascular hemolysis. The majority of patients with autoimmune anti-erythrocyte antibodies and with stage III of the disease were in the group II. The majority of patients with stage I were in groups I and III. Conclusions. Rituxim therapy reduced the frequency of autoimmune hemolytic complications. No signs of extrasvascular hemolysis were found in patients taking rituxim. Rituxim prevented the progression of the disease.