Table 1.
Infectious risk associated with autoimmune hemolytic anemia (AIHA) treatments.
| Treatment | Main Warnings | References |
|---|---|---|
| Corticosteroids | - Infectious risk is dose-dependent - Also prolonged use of low-dose steroids is associated with atypical and opportunistic infections |
[10,11,12] |
| Rituximab | - Safe as single agent - Risk of hepatitis B virus reactivation, if antiviral prophylaxis not instituted - Risk increases in chemotherapy-combined regimens or in the context of severe immunodepression (warning for PML) |
[13,14,15,16,17] |
| Splenectomy | - Infections in 6–7% of AIHA patients - Encapsulated bacteria are the main pathogens isolated in OPSI, which can be fatal - Risk decreases with proper patient’s education and vaccinations |
[18,19] |
| Classic immunosuppressive agents | - CTX, MMF, and AZA are associated with increased infectious risk by several pathogens - Cyclosporine seems safer than the abovementioned drugs |
[20,21,22] |
| Complement inhibitors | - Increased risk of encapsulated bacterial infections | [23,24] |
| BCR pathway antagonists | - PI3Kδ inhibitors are associated to PJP - Fostamatinib (used in RA patients) has an increased infectious risk |
[25,26] |
| Proteasome inhibitors | - Apparently safe in AIHA | [27,28] |
| FcRn antagonists | - Reported to be safe in ITP patients | [29,30] |
PML: progressive multifocal leukoencephalopathy, AIHA: autoimmune hemolytic anemia, OPSI: overwhelming post-splenectomy infection, CTX: cyclophosphamide, MMF: mycophenolate mofetil, AZA: azathioprine, BCR: B-cell receptor, PI3Kδ: phosphoinositide 3-kinase delta, PJP: Pneumocystis jirovecii pneumonia, RA: rheumatoid arthritis, FcRn: neonatal Fc receptor, ITP: immune thrombocytopenia.