Clinical efficacy of therapeutic whole blood exchange combined with lymphoplasmapheresis in refractory autoimmune hemolytic anemia
10.13303/j.cjbt.issn.1004-549x.2025.10.008
- VernacularTitle:全血置换联合淋巴血浆置换治疗难治性自身免疫性溶血性贫血的临床疗效
- Author:
Gang WANG
1
;
Yixin GAO
1
;
Linyan WU
1
;
Liuyan PAN
2
;
Suying HE
1
;
Lijuan ZHOU
3
;
Yongzheng PENG
1
;
Minghui YANG
1
Author Information
1. Department of Transfusion Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510220, China
2. Department of Blood Transfusion, Liuzhou People's Hospital, Liuzhou 545006, China
3. Department of Hematology, Zhujiang Hospital, Southern Medical University Guangzhou 510220, China
- Publication Type:Journal Article
- Keywords:
refractory autoimmune hemolytic anemia (AIHA);
therapeutic whole blood exchange;
lymphoplasmapheresis;
glucocorticoids
- From:
Chinese Journal of Blood Transfusion
2025;38(10):1348-1354
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the safety and efficacy of therapeutic whole blood exchange combined with lymphoplasmapheresis in the treatment of refractory autoimmune hemolytic anemia (AIHA). Methods: A retrospective analysis was performed on the clinical data of AIHA patients who underwent therapeutic whole blood exchange combined with lymphoplasmapheresis at our hospital from March 2022 to May 2025. Efficacy was assessed by comparing changes in hemoglobin, platelet count, and bilirubin levels before and after treatment. Safety was evaluated by analyzing vital signs before and after the procedure, parameters during the exchange, and adverse reactions. Results: A total of 12 AIHA patients were enrolled, completing 19 exchange procedures. The number of procedures per patient ranged from 1 to 3. The median treatment duration was 67 (65-73) minutes, with a median exchange volume of 2 025 (1 851-2 121) mL, comprising 4.5 (4-6) units of red blood cells and 1 350 (1 200-1 400) mL of plasma. Ten patients achieved partial remission, one achieved complete remission, and one showed no response, yielding an response rate of 91% (11/12). After a single session, hemoglobin increased significantly by 17.58±9.85 g/L (P<0.01), while platelets counts decreased by 45 (17.5, 79)×10
/L (P<0.05), and both systolic and diastolic blood pressure showed a significant elevation (P<0.05). However, no statistically significant differences were observed in total bilirubin, indirect bilirubin, white blood cell count, or heart rate. During the procedures, 4 adverse reactions occurred in 3 patients: one child experienced severe heart rate fluctuation twice consecutively, and two adults developed plasma allergies. All reactions resolved spontaneously without pharmacological intervention. Conclusion: The combination of therapeutic whole blood exchange and lymphoplasmapheresis appears to be a safe and effective treatment for refractory AIHA patients.
