{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:25:54Z","timestamp":1790270754248,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["eJHaem"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>We present a case of a 71\u2010year\u2010old woman with a history of high\u2010grade serous ovarian adenocarcinoma, treated with neoadjuvant chemotherapy, surgery, and adjuvant chemotherapy. A maintenance treatment combining bevacizumab and olaparib was introduced consecutively. Bevacizumab was stopped 7 months later due to neurological complications. The patient developed severe, progressive anemia, leading to significant clinical management challenges, with hemoglobin levels as low as 54 g\/L. Despite initially adapting and finally discontinuing olaparib, the patient remained transfusion dependent, without notable improvement. Common causes of anemia, such as iron deficiency, vitamin deficiency, autoimmune and infectious causes, were ruled out. Bone marrow biopsies revealed a clonal cytotoxic T\u2010LGL population and a DNMT3A mutation without evidence of myelodysplasia or metastatic infiltration. A further decline in reticulocytes and the appearance of warm autoantibodies (IgG) indicated an increasingly mixed anemia profile. High\u2010dose corticosteroids resulted in rapid hematological improvement. This case highlights a severe anemia of mixed origin with central hypo\u2010regenerative components due to prolonged PARP inhibitor toxicity and a hemolytic mechanism associated with warm autoantibodies. The prolonged toxic effect of olaparib, in conjunction with confounding factors (DNMT3A mutation, warm autoantibodies, T\u2010LGL clone), underscores the need for a comprehensive hematological assessment. The patient's response emphasizes the complexity of managing drug\u2010induced hematologic toxicity and the potential for overlapping hematologic conditions.<\/jats:p>","DOI":"10.1002\/jha2.70112","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T05:53:49Z","timestamp":1753768429000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intersecting Anemias: PARP Inhibitor\u2010Induced Toxicity and Autoimmune Hemolysis\u2014A Case Report"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7840-2033","authenticated-orcid":false,"given":"Julien","family":"Dereme","sequence":"first","affiliation":[{"name":"Service and Central Laboratory of Haematology Department of Oncology and Department of Laboratories and Pathology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL)  Lausanne 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Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Sarivalasis","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit Department of Oncology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL)  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0416-8420","authenticated-orcid":false,"given":"Gerasimos","family":"Tsilimidos","sequence":"additional","affiliation":[{"name":"Service and Central Laboratory of Haematology Department of Oncology and Department of Laboratories and Pathology Lausanne University Hospital (CHUV) and University of Lausanne (UNIL)  Lausanne 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