20 months after initial treatment for AIHA you are asked to review the patient as she is noting increasing abdominal discomfort and has started to have drenching night sweats. You note she is becoming slowly more thrombocytopenic and anaemic but her haemolysis screen is negative.
A repeat USS confirms her spleen is now 24cm with no other lymphadenopathy
Bloods: Wcc 7, Hb 95, plt 75, neu 1.3, lymph 6. LDH 300 (normal), Retic 40 (Normal), DAT negative.
Film :Atypical lymphocytes, no spherocytes
Ig M PP 3.5g/l
HIV and Hepatitis negative
What treatment would you recommend to the MDT? – please answer poll question
Is there a role for maintenance ritux in this case?