The treatment of autoimmune hemolytic anemia.

By ROBERT SCHWARTZ AND WILLIAM DAMESHEK P RIOR TO 1949, the treatment of autoimmune hemolytic anemia ( AIHA) was frequently disappointing. Despite splenectomy and the use of blood transfusions, many patients had an unremitting and progressively deteriorating course which ended fatally. With the introduction of ACTH and cortisone, the treatment of this disorder was greatly facilitated and beneficial results became far more consistent.1 Today the corticosteroids, and especially the newer synthetic agents, such as prednisone, may be said to constitute the treatment of choice in AIHA, splenectomy being reserved for refractory cases. During the past three years we have become interested in another series of compounds, the antimetabolite purine analogues, as a mode of treatment for this condition. Following the demonstration that six-mercaptopiirine ( 6-MP) could suppress immune responses in experimental animals,2’ we explored the possible value of this material in human autoimmune disease, notably in AIHA and systemic lupus, and reported the results in a preliminary paper.4 It is the purpose of this paper to present our experiences in the treatment of 14 cases of autoimmune hemolytic anemia with 6-MP and a related analogue, thioguanme.