BMJ Case Reports 2018; doi:10.1136/bcr-2017-221801
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Autoimmune haemolytic anaemia in a patient with advanced lung adenocarcinoma and chronic lymphocytic leukaemia receiving nivolumab and intravenous immunoglobulin

  1. Raja Mudad3,4
  1. 1Department of Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
  2. 2Department of Internal Medicine, University of Miami Health System, Miami, Florida, USA
  3. 3Division of Hematology/Oncology, Jackson Memorial Hospital, Miami, Florida, USA
  4. 4Division of Hematology/Oncology, University of Miami Health System, Miami, Florida, USA
  1. Correspondence to Dr Sandra D Algaze, Sandra.algaze{at}
  • Accepted 31 December 2017
  • Published 9 March 2018


We describe a rare case of severe autoimmune haemolytic anaemia (AIHA) in the setting of underlying chronic lymphocytic leukaemia receiving intravenous immunoglobulin, history of warm IgG autoantibody and treatment with nivolumab for advanced non-small cell lung cancer. In this report, we describe AIHA as a potential serious immune-related adverse event from immune checkpoint inhibitors, discuss other potential contributing factors and review previously described cases of AIHA in patients receiving programmed death 1 (PD-1) inhibitors. In the era of immunotherapy, we hope to add literature to raise awareness of potential immune-related sequelae such as AIHA. We aim to highlight the importance of close monitoring for prompt identification and management of potentially fatal AIHA and immune-related adverse events of PD-1 inhibitors by holding immunotherapy and treating with high-dose steroids, particularly in subgroups which may be at increased risk.


  • Contributors All authors contributed extensively to the article. SDA and WP identified the case, performed the literature review, drafted and edited the manuscript. RM and TJH reviewed the draft and provided critical revisions. RM was also significantly involved in the care of the patient.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article