However, in December 1998, he developed severe anemia and became transfusion-dependent. His doctor treated him with chlorambucil. When the patient was referred in April 1999, his hemoglobin was 6. We performed a bone marrow biopsy, which showed that he had pure red blood cell aplasia, a very rare condition affecting less than one percent of all CLL patients. A diagnosis of pure red blood cell aplasia requires a strong clinical suspicion and a bone marrow examination.
Treatment is with immunosuppression.
We started the patient on prednisone at one milligram per kilogram per day. His hemoglobin rose almost immediately and within two weeks had reached about 12. He has been maintained on 15 milligrams of prednisone on alternate days with no complications for the past four months. These three cases are typical in many ways. Most CLL patients will eventually die from humoral dysfunction, bone marrow failure, transformation to high-grade lymphoma or a second malignancy.