From the FDA Drug Label
A single occurrence of transient aplastic anemia (pure red cell aplasia) and two occurrences of hemolytic anemia following RITUXAN therapy occurred during the single-arm studies
The type of hemolytic crisis is not specified as vascular or extravascular in the provided drug label.
From the Research
Hemolytic crisis can be both vascular and extravascular, depending on the underlying cause, with vascular hemolysis requiring immediate intervention to prevent kidney damage and extravascular hemolysis management focusing on treating the underlying cause and supporting the patient through the crisis. The distinction between vascular and extravascular hemolysis is crucial for treatment approaches, as vascular hemolysis may lead to acute kidney injury due to the release of free hemoglobin into the plasma, while extravascular hemolysis is more common and occurs when damaged or abnormal red blood cells are removed by macrophages in the spleen and liver 1. Some key points to consider in the management of hemolytic crisis include:
- Laboratory findings to differentiate between vascular and extravascular hemolysis, such as higher levels of free hemoglobin in plasma and hemoglobinuria in vascular hemolysis, and increased unconjugated bilirubin and no hemoglobinuria in extravascular hemolysis 2, 1
- Treatment approaches, including immediate intervention to prevent kidney damage in vascular hemolysis and treating the underlying cause and supporting the patient through the crisis in extravascular hemolysis 3, 4
- The role of corticosteroids in the treatment of warm autoimmune hemolytic anemia, with parenteral regimens showing a higher response rate compared to oral prednisolone 4
- The impact of hemolysis on immune regulation, including the formation of neutrophil extracellular traps, inhibition of oxidative burst, and impairment of macrophage phagocytosis and microbial clearance 5