This paper reported a 15-year-old girl with β-thalassemia major became dependent on blood transfusions from 6 months after birth whose blood transfusion needs increased with age. The girl started treatment with thalidomide at the age of 15. She became transfusion independent one month after starting thalidomide treatment, and her hemoglobin levels were maintained at 98-109 g·L-1. However, the girl subsequently developed symptoms of dizziness and fatigue in the 11th month of thalidomide treatment. Her hemoglobin was decreased and indirect antiglobulin test and direct antiglobulin test were positive. She was diagnosed with new onset autoimmune hemolytic anemia, which was considered to be related to thalidomide, and the association of adverse reactions was evaluated as "possible". Indirect antiglobulin test and direct antiglobulin test were negative after drug withdrawal and glucocorticoid therapy. Therefore, patients with thalassemia who are treated with thalidomide should be carefully monitored for the development of autoimmune hemolytic anemia.
1.Taher AT, Musallam KM, Cappellini MD. β-Thalassemias[J]. N Engl J Med, 2021, 384(8): 727-743. DOI: 10.1056/NEJMra2021838.
2.Musallam KM, Taher AT, Cappellini MD, et al. Clinical experience with fetal hemoglobin induction therapy in patients with beta-thalassemia[J]. Blood, 2013, 121(12): 2199-2212. DOI: 10.1182/blood-2012-10-408021.
3.Chen JM, Zhu WJ, Liu J, et al. Safety and efficacy of thalidomide in patients with transfusion-dependent beta-thalassemia: a randomized clinical trial[J]. Signal Transduct Target Ther, 2021, 6(1): 405. DOI: 10.1038/s41392-021-00811-0.
4.Li X, Hu S, Liu Y, et al. Efficacy of thalidomide treatment in children with transfusion dependent beta-thalassemia: a retrospective clinical study[J]. Front Pharmacol, 2021, 12: 722502. DOI: 10.3389/fphar.2021.722502.
5.Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions[J]. Clin Pharmacol Ther, 1981, 30(2): 239-245. DOI: 10.1038/clpt.1981.154.
6.Lechner K, Jager U. How I treat autoimmune hemolytic anemias in adults[J]. Blood, 2010, 116(11): 1831-1838. DOI: 10.1182/blood-2010-03-259325.
7.中华医学会血液学分会红细胞疾病(贫血)学组. 中国成人自身免疫性溶血性贫血诊疗指南(2023年版)[J]. 中华血液学杂志, 2023, 44(1): 12-18. DOI: 10.3760/cma.j.issn.0253-2727.2023.01.003.
8.Brodsky RA. Warm autoimmune hemolytic anemia[J]. N Engl J Med, 2019, 381(7): 647-654. DOI: 10.1056/NEJMcp1900554.
9.Jager U, Barcellini W, Broome CM, et al. Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendations from the First International Consensus Meeting[J]. Blood, 2020, 41: 100648. DOI: 10.1016/j.blre.2019.100648.
10.Witzens M, Moehler T, Neben KF, et al. Development of leukocytoclastic vasculitis in a patient with multiple myeloma during treatment with thalidomide[J]. Ann Hematol, 2004, 83(7): 467-470. DOI: 10.1007/s00277-003-0804-0.
11.Erdem F, Gundogdu M, Kiki I, et al. Autoimmune thyroiditis during thalidomide treatment[J]. Am J Hematol, 2006, 81(2): 152. DOI: 10.1002/ajh.20480.
12.Darabi K, Kantamnei S, Wiernik PH. Lenalidomide-induced warm autoimmune hemolytic anemia [J]. J Clin Oncol, 2006, 24(35): e59. DOI: 10.1200/JCO.2006.08.4053.
13.Lim MY, Raval JS, Richards KL, et al. Lenalidomide-associated hemolytic anemia[J]. Leuk Lymphoma, 2015, 56(9): 2717-2719. DOI: 10.3109/10428194.2014.1003558.
14.Stewart AK. Medicine. How thalidomide works against cancer[J]. Science, 2014, 343(6168): 256-257. DOI: 10.1126/science.1249543.
15.Hoyer KK, Kuswanto WF, Gallo E, et al. Distinct roles of helper T-cell subsets in a systemic autoimmune disease[J]. Blood, 2009, 113(2): 389-395. DOI: 10.1182/blood-2008-04-153346.
16.Al-Awadhi AM, Alfadhli SM, Al-Khaldi D, et al. Investigation of the distribution of lymphocyte subsets and zinc levels in multitransfused beta-thalassemia major patients[J]. Int J Lab Hematol, 2010, 32(2): 191-196. DOI: 10.1111/j.1751-553X.2009.01161.x.
17.付蓉, 于虹. 我如何诊断和治疗自身免疫性溶血性贫血 [J]. 中华血液学杂志, 2022, 43(11): 910-915. [Fu R, Yu H. How I diagnose and treat autoimmune hemolytic anemia[J]. Chinese Journal of Hematology, 2022, 14, 43(11): 910-915.] DOI: 10.3760/cma.j.issn.0253-2727.2022.11.005.