Hemoglobin was 7, and the reticulocyte count was 14.1 percent. Platelets were normal at 336,000. The diagnosis was confirmed by an antiglobulin test which was positive for C3 and immunoglobulin. CLL is the most common secondary cause of hemolytic anemia, amounting to about 1,000 cases per year. The antibodies are usually directed against the red blood cell Rh antigen.
Treatment is immunosuppression.
We treated this patient with prednisone at one milligram per kilogram per day. Within two weeks, his hemoglobin was 12 and his white blood cell count began to fall. He has been successfully maintained on low-dose prednisone for the past year. His absolute lymphocyte count was 8,300. Hemoglobin was 6.1, and platelets were only 5,000.