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<p>To explore the clinical characteristics of pembrolizumab induced autoimmune hemolytic anemia (AIHA) and to provide references for diagnosis, treatment and prognosis. Case reports and case series of pembrolizumab induced AIHA were collected by searching the database and the clinical data of patients were summarized for statistical analysis up to August 31, 2025. Sixteen cases (55.2%) of male patients and 13 cases (44.8%) of female patients were included, with a median age of 69&#xa0;years (36,85). The median time to develop AIHA after the first administration was 30&#xa0;days (range 10,780), and the median cycle was 2.5 cycles (range 1,33). Clinical symptoms can be manifested as fatigue (13.8%), shortness of breath (10.3%), dyspnea (10.3%) and dizziness (6.9%). Direct antiglobulin test showed negative results (17.2%). Warm AIHA accounted for 44.8% of pembrolizumab induced AIHA. Peripheral blood smear examination showed spherocytes (20.7%), red cell agglutination (10.3%). After discontinuation of pembrolizumab and treatment with glucocorticoids (100%) and red blood cell infusion (69.0%), 96.5% of the patients achieved a treatment response. AIHA is a rare and serious complication of pembrolizumab. Clinicians should be aware of the possibility of AIHA occurrence during the treatment process. DAT negativity does not rule out pembrolizumab -induced AIHA. Glucocorticoids may be an important option for the treatment of AIHA. For refractory AIHA, second-line treatment needs to be initiated.</p>

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Clinical features, treatment and outcomes of pembrolizumab induced autoimmune hemolytic anemia

  • 期刊论文

  • 发表日期：

    2026年1月9日

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  • Jieqiong Liu,
  • Wei Sun,
  • Chunjiang Wang

摘要

To explore the clinical characteristics of pembrolizumab induced autoimmune hemolytic anemia (AIHA) and to provide references for diagnosis, treatment and prognosis. Case reports and case series of pembrolizumab induced AIHA were collected by searching the database and the clinical data of patients were summarized for statistical analysis up to August 31, 2025. Sixteen cases (55.2%) of male patients and 13 cases (44.8%) of female patients were included, with a median age of 69 years (36,85). The median time to develop AIHA after the first administration was 30 days (range 10,780), and the median cycle was 2.5 cycles (range 1,33). Clinical symptoms can be manifested as fatigue (13.8%), shortness of breath (10.3%), dyspnea (10.3%) and dizziness (6.9%). Direct antiglobulin test showed negative results (17.2%). Warm AIHA accounted for 44.8% of pembrolizumab induced AIHA. Peripheral blood smear examination showed spherocytes (20.7%), red cell agglutination (10.3%). After discontinuation of pembrolizumab and treatment with glucocorticoids (100%) and red blood cell infusion (69.0%), 96.5% of the patients achieved a treatment response. AIHA is a rare and serious complication of pembrolizumab. Clinicians should be aware of the possibility of AIHA occurrence during the treatment process. DAT negativity does not rule out pembrolizumab -induced AIHA. Glucocorticoids may be an important option for the treatment of AIHA. For refractory AIHA, second-line treatment needs to be initiated.