Anemia complicating chronic lymphocytic leukemia may have various causes: blood loss, depressed erythropoiesis associated with leukemic infiltration of the bone marrow,1,2 folic acid deficiency,3 and hemolysis.1,2 Shortening of red blood cell survival is frequent in chronic lymphocytic leukemia,4,5 but only in some patients the hemolysis becomes "overt." Severe anemia develops4 when the bone marrow is not able to compensate for the accelerated red cell destruction. Then there may be jaundice with elevated indirectreacting serum bilirubin, spherocytosis with increased osmotic fragility, reticulocytosis, a positive Coombs test,4 cold or warm agglutinins,4,6 and leukemic infiltration with erythroid hyperplasia of the bone marrow.
Hemolytic anemia in chronic lymphocytic leukemia may be so severe as to be the main problem requiring intensive treatment. Remission of the hemolytic anemia has followed antileukemic therapy, such as alkylating drugs and spray irradiation5 or by corticoid hormones.2,5,7 Splenectomy has been
DJALDETTI M, DE VRIES A, LEVIE B. Hemolytic Anemia in Lymphocytic Leukemia: Treatment by Irradiation of the Spleen. Arch Intern Med. 1962;110(4):449–455. doi:10.1001/archinte.1962.03620220041007
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