Discussions that mention cytoxan

Anemia board


So, the Evan's syndrome is IgM mitigated ONLY? Or
does he also have IgG? I presume only IgM because
the first thing they look for is warm antibody
hemolytic anemia.

IgM antibodies are a tough nut to crack. What
are your husband's hemoglobin counts running
at? How low are the platelets?

Christina had Evan's syndrome with both warm
and cold (IgG and IgM) antibodies. Splenectomy
has apparently (knock on wood) "cured" her. The
surgery might help your husband's platelets
but almost surely would NOT help the IgM.

There is one treatment that I notice is missing
on your list and you should talk with your
doc's about it. It is called "rituxan".
It is a monoclonal antibody for treating
lymphoma. I know a woman who has taken it for
cold antibody and she raised her counts from
around 6.0 to 8.5 - 9.0 range. Thus it hasn't
been a total cure, but it helped. It is not a
chemotherapy so the side effects would be much
more tolerable than Cytoxan.


Best of luck,

George F.
Onisa,

Either diverticuli or hemolytic anemia could cause
the low hgb counts. 4.8 is pretty low. My wife
bottomed out at 3.9 back when she had AIHA and
she was a sick girl at that point. I presume they
have done a DAT to test for IgG (if it is present
it can be treated with prednisone).

Merrie,

Your docs probably told you that the presence of
hemolytic anemia and thrombocytopenia is called
"Evan's Syndrome" and the thinking is the symptoms
are a manifestation of a single causal factor.
From my studies, prednisone is *NOT* a treatment
for cold agglutinans. Did you also test positive
for warm antibody AIHA? Probably so. If that is
the case you have the "mixed case", same exact
thing my wife had. In her case a splenectomy
"cured" her, she is 2 years past the surgery with
no relapse. If you can't get down to less than
10 mg/day of prednisone and a normal hgb count I
would recommend trying the surgery if they suggest
it. However, it doesn't work on everybody, we know
a couple of people who relapsed after the operation.
Besides the surgery my wife took Cytoxan and had
plasma exchange to treat the anemia.

SC,

The talk of cold agglutinins (IgM antibodies)
here refers to "too many" of them rather than too few.
In IgM mitigated AIHA, the IgM become self
sensitised, i.e. they are "auto-antibodies" that
attack the body's healthy red blood cells along
with invading germs.

I would ask the doctor if the lack of a spleen
is the cause of your low IgM count. The spleen
is part of the immune complex and makes all sorts
of antibodies. It could be that your low IgM count
is now normal for you and when you get sick your
other immune system components kick in to take
care of things. I'd have the full workup to
rule everything out, but at the same time
not worry too much about it unless
it is making you sick.
Quote from georgef:
Onisa,

Either diverticuli or hemolytic anemia could cause
the low hgb counts. 4.8 is pretty low. My wife
bottomed out at 3.9 back when she had AIHA and
she was a sick girl at that point. I presume they
have done a DAT to test for IgG (if it is present
it can be treated with prednisone).

Merrie,

Your docs probably told you that the presence of
hemolytic anemia and thrombocytopenia is called
"Evan's Syndrome" and the thinking is the symptoms
are a manifestation of a single causal factor.
From my studies, prednisone is *NOT* a treatment
for cold agglutinans. Did you also test positive
for warm antibody AIHA? Probably so. If that is
the case you have the "mixed case", same exact
thing my wife had. In her case a splenectomy
"cured" her, she is 2 years past the surgery with
no relapse. If you can't get down to less than
10 mg/day of prednisone and a normal hgb count I
would recommend trying the surgery if they suggest
it. However, it doesn't work on everybody, we know
a couple of people who relapsed after the operation.
Besides the surgery my wife took Cytoxan and had
plasma exchange to treat the anemia.

SC,

The talk of cold agglutinins (IgM antibodies)
here refers to "too many" of them rather than too few.
In IgM mitigated AIHA, the IgM become self
sensitised, i.e. they are "auto-antibodies" that
attack the body's healthy red blood cells along
with invading germs.

I would ask the doctor if the lack of a spleen
is the cause of your low IgM count. The spleen
is part of the immune complex and makes all sorts
of antibodies. It could be that your low IgM count
is now normal for you and when you get sick your
other immune system components kick in to take
care of things. I'd have the full workup to
rule everything out, but at the same time
not worry too much about it unless
it is making you sick.


Hi I was just reading your post re: your wife hope she is doing good it sounds like it. You mentioned that she had a splenectomy, I am having my removed on Wed. due to hemolytic anemia. I have been taking prednisone since Aug. and have had hemoglobin drip, procrit shots, but nothing has brought my blood counts up I am holding @ 8.9 so I have decided to give up my spleen. Hope I this will be my "Cure" :)