2022 Volume 68 Issue 4 Pages 486-490
The patient was a 63-year-old man with non-small cell lung cancer. He was treated with nivolumab as second-line therapy. On the 68th day, nivolumab was discontinued due to pneumonitis. On the 111th day, rash, liver dysfunction and pneumonitis were observed and administration of systemic steroid was started. On the 115th day, the sudden progression of anemia required blood transfusion. The irregular antibody test and direct antiglobulin test were positive. The antibody dissociation test showed non-specificity of autoantibodies. On ZZAP treatment, his blood type was B, Rh blood type was CcDee, and no alloantibodies were identified. He was diagnosed with autoimmune hemolytic anemia (AIHA) and was transfused with a total of 12 units of weakly aggregation-reactive and E-antigen-negative red blood cells. The hemolytic anemia gradually improved with steroid pulse therapy. AIHA as an immune-related adverse event is typically severe and requires blood transfusion, which in turn requires the prompt determination of blood type and securing of red blood cell products with low reactivity.
