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Autoimmune Hemolytic Anemia and Neoplasia of the Reticuloendothelium: With a Hypothesis Concerning Etiologic Relationships

BERNARD PIROFSKY, M.D., F.A.C.P.
Ann Intern Med. 1968;68(1):109-121. doi:10.7326/0003-4819-68-1-109
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SUMMARY:

Two hundred thirty-four cases of autoimmune hemolytic anemia were analyzed, and 114 examples of neoplasia of the reticuloendothelium were found. The temporal sequence of this association was examined. In 31.6% of the cases both states were simultaneously discovered. The neoplastic process preceded autoimmune hemolytic anemia in 61.4% of the series. In 7 patients with 8 neoplastic growths (a prevalence of 7%) autoimmune hemolytic anemia occurred before neoplasia.

It is suggested that neither autoimmune hemolytic anemia nor reticuloendothelial neoplasia is directly involved in creating the other state. The hypothesis is developed that an immunologic aberration is present in such patients that prevents the establishment of a normal immune homeostatic mechanism. The survival of immunocompetent cells, which have been modified by viruses or somatic mutation, in the face of a defective immune apparatus may result in either autoimmune hemolytic anemia, reticuloendothelial neoplasia, or both conditions. In addition, such an abnormality may also lead to other associated neoplastic and autoimmune disease processes.

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