Mycophenolate Mofetil Induced Remission in Steroid-Refractory Autoimmune Hemolytic Anemia/Mikofenolat Mofetil ile Remisyon Saglanan Steroide Direncli Otoimmun Hemolitik Anemi

Autoimmune hemolytic anemia (AIHA) is a disease that is seen in 1/10.000 people and characterized by forming antibodies against red blood cells and degradation of these red blood cells in reticuloendothelial system. Even autoimmune diseases can accompany, it is seen usually idiopathic. Paleness due to anemia, jaundice, tachycardia, darkening in urine color, hepatosplenomegaly are frequently seen clinical findings. Clinically normochrome and normocytic anemia, reticulocytosis, polychromasia in peripheral smear, spherocytes, indirect hyperbilirubinemia and increased lactate dehydrogenase are seen. Direct coombs test is the diagnostic test. Steroids are the first line drugs in treatment. The dosage and the treatment duration is formed according to patient's clinical situation. The treatment is checked by complete blood count, reticulocyte and Coombs test. Immunosuppressor treatments are given to patients that don't respond to treatment in 4-6 weeks or less patients who has recurrence at the time of decreasing the treatment dosage of corticosteroids. In few patient, that did not respond steroids, immunosuppressive treatments are used. Here, we present a patient, who is diagnosed with AIHA that we couldn't manage remission by steroid treatment, and no response to rituxumab as an immunosuppressor, but treated successfully with microphenolat mofetil. Keywords Steroid, autoimmune hemolytic anemia, mycophenolate mofetil Otoimmun hemolitik anemi (OIHA), eritrosit antijenlerine karsi antikor olusmasi, antikorla kaplanmis eritrositlerin retikuloendotelyal sistemde yikimi ile karakterize, 1/10,000 siklikta gorulen bir hastaliktir. Otoimmun hastaliklar eslik edebilecegi gibi genelde idiyopatik olarak gorulmektedir. Anemiye bagli solukluk, sarilik, tasikardi, idrar renginde koyulasma, hepatosplenomegali sik gorulen klinik bulgular arasinda yer almaktadir. Genellikle normokrom ve normositer anemi, retikulositoz, periferik yaymada polikromozi, sferosit, indirekt hiperbilirubinemi, laktat dehidrogenaz artisi gorulmektedir. Direkt Coombs testi tanisal tetkiktir. Tedavide steroidler ilk tercihtir. Tedavinin dozu ve suresi hastanin klinigine gore duzenlenmektedir. Tam kan sayimi, retikulosit ve Coombs testi ile tedavi takip edilmektedir. Dort-alti haftada yanit alinamayan hastalarda veya kortikosteroid tedavisinin azaltildigi donemde tekrar nuks eden daha az olguda ise immunosupresor tedaviler uygulanmaktadir. Burada, OIHA tanisi konulan ve steroid tedavisi ile remisyon saglayamadigimiz immunosupresif tedavilerden rituksimab tedavisine cevap alamadigimiz mikofenolat mofetil ile tedavi edilen goren bir olgu sunulmustur. Anahtar Kelimeler Steroid, otoimmun hemolitik anemi, mikofenolat mofetil