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HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2024 51 Lesley Meng, MD Medical Oncology Terrebonne General | Mary Bird Perkins Cancer Center second- and third-line therapies such as intravenous immunoglobulin, monoclonal antibodies, and at times even require splenectomy. Treating a patient with both cancer, such as CML, and hemolysis, such as autoimmune hemolytic anemia, requires a delicate balance and a multidisciplinary approach. Using immunosuppressive medications such as steroids in cancer patients on active therapy can increase the risk of sepsis and death. These patients need close monitoring of their clinical symptoms. Regular monitoring of blood counts and disease markers will help in making adjustments to the therapeutic regimen. n REFERENCES 1 Yassin, M.; Hamamyh, T. “Autoimmune Hemo- lytic Anemia in Chronic Myeloid Leukemia from Busulfan to the Era of Tyrosine Kinase Inhibi- tors.” Blood 134, Issue 1, Supplement 1 (November 2019): 5917- 5922. 2 Hamamyh, T.; Yassin, M. “Autoimmune Hemo- lytic Anemia in Chronic Myeloid Leukemia.” Phar- macology 105, Issues 11-12 (November 2020): 630-638. DOI: 10.1159/000507295 Lesley Meng, MD, is a medical oncologist who practices atTerrebonne General | Mary Bird Perkins Cancer Center and is board certified in internal medicine, hematology, and medical oncology. She has over 15 years of experience in the medical field as a hematologist oncologist. Meng earned a Doctor of Medicine from the Louisiana State University School of Medicine in New Orleans and a Master of Business Administration from Southeastern Louisiana University. She completed an internal medicine residency and a hematology/ oncology fellowship at LSU Health Sciences Center. G was more common in these patients than cold antibodies with intravascular hemolysis mediated by immunoglobulin M. When suspected, the diagnosis for CML is confirmed by the presence of the BCR- ABL1 gene fusion. The common presentation of symptoms despite the underlying etiology of hemolysis includes fatigue, weakness, pallor, shortness of breath, tachycardia, and, more often than not, splenomegaly. The presence of complement or immunoglobulin on the RBC’s surface is detected by the direct antiglobulin test otherwise known as the Coombs test. Other laboratory findings include an elevated LDH and decreased haptoglobin with the presence of spherocytes on a peripheral blood smear. Unlike anemia with DIC, which resolves with treating the underlying condition that caused the hemolysis to occur,AIHAdoes not respond to the usual treatment of CML, tyrosine kinase inhibitors. AIHA may occur in patients receiving treatment for CML, and in these patients it is thought to be medication-induced. Medications that can cause AIHA include interferon, busulfan, andcertainantibiotics used prophylactically to prevent infection — for example, dapsone and Bactrim. Regardless of the etiology, steroids remain as first-line treatment with oral prednisone at a dose of 1 mg/kg per day. Patients who are refractory to steroids qualify for CHRONIC MYELOGENOUS LEUKEMIA (CML) is a myeloproliferative neoplasm where granulocytes in the bone marrow undergo unregulated proliferation caused by the fusion of the BCR gene on chromosome 22 with the ABL1 gene on chromosome 9, which occurs spontaneously. Blood work frequently reveals elevated white blood cell counts above 50,000 and platelet counts above 600,000 with mild anemia to where the hemoglobin is close to 10. However, there are rare instances when the white count and platelet count are not drastically elevated, yet the hemoglobinmay be closer to 6. In these cases, do not discount CML from the differential diagnosis as there are rare cases where autoimmune hemolytic anemia (AIHA) is the main presenting symptom for some of these patients. Autoimmune hemolytic anemia (AIHA) occurs when the immune system mistakenly attacks and destroys the patient’s red blood cells (RBCs) through a reaction with the red blood cell’s surface antigen. This process can be associated with certain malignancies, which produce autoantibodies. This finding is not commonly noted in patients with chronic myelogenous leukemia, but it is important to note it in the differential as this can be the presenting symptom and the diagnosis could be overlooked. It is worth noting that warm AIHA with extravascular hemolysis mediated by immunoglobulin “Autoimmune hemolytic anemia (AIHA) occurs when the immune systemmistakenly attacks and destroys the patient’s red blood cells (RBCs) through a reaction with the red blood cell’s surface antigen.”