Successful Treatment of Autoimmune Hemolytic Anemia Concurrent With Gastric Cancer by Rituximab: A Case Report of Evans Syndrome
Evans syndrome is a disorder characterized by combined autoimmune
hemolytic anemia and immune thrombocytopenia.
Although several previous reports were present,
Evans syndrome with concurrent malignancy is rare,
The first-line treatment for AIHA and ITP is steroids, but steroid therapy
to diabetic patient is almost contradictory.
The second-line treatment is immunosuppressants and/or splenectomy.
In recent years, efforts have been made to establish evidence supporting
the use of rituximab for steroid-resistant patients. In the present case of Evans syndrome
with concurrent gastric cancer, steroid therapy improved ITP,
but AIHA was steroid resistant. Rituximab was effective for steroid-resistant AIHA in the present case.
In December 2010, the patient felt general fatigue which deteriorated.
In February 2011, he consulted a local physician for close check-up, and was found to have
anemia with a hemoglobin (Hb) concentration of 7.g/dl.
Upper gastrointestinal endoscopy revealed ulcerated lesions on the lesser curvature near the pyloric region.
Biopsy of the lesion.
revealed funicular and sheet-like proliferative invasion of signet-ring cell-type cancer with the
diagnosis of poorly differentiated stage IIc gastric cancer.
Although exacerbation of hemolysis was afraid due
to blood typing and cross-matching test, and a compatible blood
transfusion was challenging, a total of six units of RBC were
transfused, and no clear deterioration of hemolytic findings
happened following transfusion. Anemia persisted, however,
and signs of cardiac failure developed.
Intern Med Open J. 2016; 1(1): 1-5. doi: 10.17140/IMOJ-1-101