{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:33:32Z","timestamp":1787016812454,"version":"build-2736575974"},"reference-count":19,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,11,19]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>Increasing numbers of patients are now offered immunotherapy as part of their cancer treatment. These treatments, while often very effective, have a wide range of adverse effects that are distinct from those of traditional chemotherapy regimens. Thyroid disease, dermatological disease, colitis and pneumonitis are some of the most commonly reported immune side effects. We present a case of life-threatening de novo autoimmune haemolytic anaemia (AIHA) complicated by immune cholangitis induced by pembrolizumab. An 81-year-old woman with metastatic melanoma completed a two-year course of pembrolizumab in August 2018 and six\u2009weeks later presented to hospital with jaundice. Admission haemoglobin (Hb) was 91\u2009g\/L, rapidly decreasing to 31\u2009g\/L, at which point she required admission to the intensive care unit. AIHA is a rare but potentially life-threatening complication of checkpoint inhibitors and should be considered in patients presenting with anaemia during or after immunotherapy treatment.<\/jats:p>","DOI":"10.1136\/bcr-2019-232505","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T05:05:44Z","timestamp":1575608744000},"page":"e232505","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Pembrolizumab-induced autoimmune haemolytic anaemia and cholangitis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8009-9236","authenticated-orcid":false,"given":"Harriet","family":"Williams","sequence":"first","affiliation":[{"name":"Haematology Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Aitchison","sequence":"additional","affiliation":[{"name":"Haematology Department, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,5]]},"reference":[{"key":"2025082711452078000_12.12.e232505.1","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/j.immuni.2018.06.003","article-title":"Immune checkpoint blockade across the cancer care continuum","volume":"48","author":"Helmink","year":"2018","journal-title":"Immunity"},{"key":"2025082711452078000_12.12.e232505.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00083-2"},{"key":"2025082711452078000_12.12.e232505.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1503093"},{"key":"2025082711452078000_12.12.e232505.4","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1016\/S2352-3026(18)30175-3","article-title":"Haematological immune-related adverse events induced by anti-PD-1 or anti-PD-L1 immunotherapy: a descriptive observational study","volume":"6","author":"Delanoy","year":"2019","journal-title":"The Lancet Haematology"},{"key":"2025082711452078000_12.12.e232505.5","doi-asserted-by":"publisher","DOI":"10.1097\/00000421-198212000-00014"},{"key":"2025082711452078000_12.12.e232505.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0160221"},{"key":"2025082711452078000_12.12.e232505.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2015.11.016"},{"key":"2025082711452078000_12.12.e232505.8","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/annonc\/mdz011","article-title":"Five-Year survival outcomes for patients with advanced melanoma treated with pembrolizumab in KEYNOTE-001","volume":"30","author":"Hamid","year":"2019","journal-title":"Ann Oncol"},{"key":"2025082711452078000_12.12.e232505.9","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/ejh.13187","article-title":"Autoimmune hemolytic anemia associated with the use of immune checkpoint inhibitors for cancer: 68 cases from the food and drug administration database and review","volume":"102","author":"Tanios","year":"2019","journal-title":"Eur J Haematol"},{"key":"2025082711452078000_12.12.e232505.10","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/ajh.25448","article-title":"Clinical and laboratory features of autoimmune hemolytic anemia associated with immune checkpoint inhibitors","volume":"94","author":"Leaf","year":"2019","journal-title":"Am J Hematol"},{"key":"2025082711452078000_12.12.e232505.11","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1097\/CMR.0000000000000232","article-title":"Autoimmune hemolytic anemia induced by anti-PD-1 therapy in metastatic melanoma","volume":"26","author":"Kong","year":"2016","journal-title":"Melanoma Res"},{"key":"2025082711452078000_12.12.e232505.12","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s10637-018-0561-5","article-title":"Exacerbation of autoimmune hemolytic anemia induced by the first dose of programmed death-1 inhibitor pembrolizumab: a case report","volume":"36","author":"Ogawa","year":"2018","journal-title":"Invest New Drugs"},{"key":"2025082711452078000_12.12.e232505.13","unstructured":"Sherbeck JP , Hugan S , Novak B , et al . Pembrolizumab induced autoimmune hemolytic anemia with possible auto-anti-EN(A)FS specificity. Transfusion 2018;58."},{"key":"2025082711452078000_12.12.e232505.14","doi-asserted-by":"crossref","unstructured":"Khan U , Ali F , Khurram MS , et al . Immunotherapy-associated autoimmune hemolytic anemia. j. immunotherapy cancer 2017;5.doi:10.1186\/s40425-017-0214-9","DOI":"10.1186\/s40425-017-0214-9"},{"key":"2025082711452078000_12.12.e232505.15","doi-asserted-by":"crossref","unstructured":"Shaikh H , Daboul N , Albrethsen M , et al . A case of autoimmune haemolytic anaemia after 39 cycles of nivolumab. 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