Rituximab therapy in a patient with autoimmune hemolytic anemia and immune thrombocytopenia associated with chronic lymphocytic leukemia

Autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia are relatively common in chronic lymphocytic leukemia (CLL), but the presence of both in the same patient is rare. The combination of AIHA and immune thrombocytopenia is known as Evans syndrome which is an idiopathic disorder without an underlying cause. [1] Evans syndrome may also develop as a secondary syndrome in association with a variety of conditions like CLL, systemic lupus erythematosus (SLE) and following autologous or allogeneic stem cell transplantation. This syndrome can be resistant to a variety of therapeutic measures and associated with significant morbidity and mortality. Rituximab is a monoclonal antibody against CD20 antigen present on Bmlymphocytes. It has shown promise in the treatment of many hematologic and nonmhematologic immunologic disorders. We present the case of a 68myearmold patient with AIHA and immune thrombocytopenic purpura (ITP) associated with CLL and discuss the role of rituximab in its management.