Immunotherapy-associated Autoimmune Hemolytic Anemia

Hematol Oncol Clin North Am. 2022 Apr;36(2):365-380. doi: 10.1016/j.hoc.2021.11.002.


Over the past decade, the role of immunotherapy treatment in cancer has expanded; specifically, indications for immune checkpoint inhibitors (ICI) have multiplied and are used as first-line therapy. ICIs include cytotoxic T-lymphocyte-associated protein 4 and programmed cell death protein 1 inhibitors, as monotherapies or in combination. Autoimmune hemolytic anemia (AIHA) has emerged as a rare yet serious immune-related adverse event in ICI use. This review describes diagnosis and management of immunotherapy related AIHA (ir-AIHA) including an algorithmic approach based on severity of anemia. Suggested mechanisms are discussed, guidance on ICI resumption provided and prognosis reviewed including risk of recurrence.

Keywords: Autoimmune hemolytic anemia; Immune checkpoint inhibitors; Immune-related adverse event; Immunotherapy.

Publication types

  • Review

MeSH terms

  • Anemia, Hemolytic, Autoimmune* / chemically induced
  • Anemia, Hemolytic, Autoimmune* / diagnosis
  • Humans
  • Immune Checkpoint Inhibitors
  • Immunologic Factors / therapeutic use
  • Immunotherapy / adverse effects
  • Neoplasms* / drug therapy


  • Immune Checkpoint Inhibitors
  • Immunologic Factors