Heparin Therapy in Autoinirnune Hemolytic Anemia

T PRESENT, corticosteroids and splenectomy constitute the main forms of therapy in autoimmune hemolytic anemia. In general, the patient is given a large dose of prednisone for a short period until the hemolytic process aI)ates, then the dose of corticosteroid is reduced to the minimum (lose which controls the disease.’ If this maintenance dose for tile individual patient is too high to permit prolonged administration without producing undesirai)le side effects of hypercorticism, splenectomy must be considered. Opinions appear to differ, however, on tile length of time one is justified in (lelaying splenectomy when response to corticosteroids is suboptimal. One reason for reluctance to undertake splenectomy early in management of a case is the relatively high relapse rate following the procedure. This has been recognized for a number of years and is as high as 50 per cent in some series. \Vhen relapse does occur following splenectoiny, corticosteroids may be helpful, but occasionally one is confronted with a patient in wllom it is impossible to produce a remission with either splenectomy or corticosteroids. In such cases, courses of nitrogen mustard have been administered in an effort to ameliorate the disease by depressing antibody formation.2 Results have been generally unsatisfactory. In 1956, Tocantins and \Vangl reported the use of radioactive gold intravenously in seven patiellts vho had relapsed following splenectomy. Six of the seven had partial or complete control of the hemolytic process for variable periods following the injections. Owren4 was first to attempt to treat autoimmune hemolytic anemia with heparin. A 74 year old man, with severe hemolytic anemia, was given 350 mg. of heparin daily for nine days and later 800 mg. daily for six days. Tile smaller dose had little effect on the rate of hemolysis, whereas the larger dose appeared to control the disease quite effectively. Unfortunately, heparin had to be discontinued because of a bleeding tendency so the results were inconclusive. Noteworthy, however, was the rapid return of severe hemolysis upon cessation of heparin. In 1956, Storti, Vaccari and Baldini5 reported a clinical trial of heparin ill autoimmune hemolytic anemia with good evidence of beneficial results from 250 mg. daily over a period of 30 days. When the patient became asymptomatic, he discontinued heparin without consultation and “...a gain showed a violent onset of the hemolytic process.” Roth and Frumin#{176} in 1956 demonstrated decreases in direct and indirect