Autoimmune hemolytic anemia with reticulocytopenia and erythroid marrow

We have observed five patients with AIHA in whom episodes of unexplainable reticulocytopenia and life-threatening anemia were associated with an intensely erythroid marrow. In one patient the mechanism of the reticulocytopenia was investigated; our data showed that radioactive iron was retained in the marrow and did not appear in circulating red cells. The autoantibody in this patient's serum reacted more strongly with normal red cells that were reticulocyte poor than with those that were reticuloycyte rich, suggesting that reticulocytes were not preferentially destroyed. Remission of anemia was associated with reticulocytosis, the appearance of radioactive iron in circulating erythrocytes, and a decrease in titer of the serum autoantibody. The antibody appears to have reacted with marrow cells, preventing their release into the blood.