1
|
Radhakrishnan N, Dua S, Arora S. IgA-mediated autoimmune hemolytic anemia in an infant. Transfus Apher Sci 2019; 59:102695. [PMID: 31862428 DOI: 10.1016/j.transci.2019.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/08/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022]
Abstract
Autoimmune Hemolytic anemia (AIHA) a relatively uncommon form of hemolytic anemia in children, occurs due to the premature destruction of red blood cells caused by presence of autoantibodies directed against antigens on RBCs. Warm reactive AIHA is the most common form due to IgG isotype of immunoglobulin class binding to autologous RBCs at 370C and confirmed with a positive DAT screening. We present a case of DAT-negative primary warm AIHA in an infant due to IgA antibody. A 10 month old male infant presented with dark colored urine and irritability for past two months, with associated history of fever, diarrhea and vomiting. He had received one red cell transfusion 10 days prior. On physical examination he had pallor with tachycardia without splenomegaly. On investigation his hemoglobin was 5.8 g/dl, WBC 25.9 × 103/mm3 and normal platelets counts. Peripheral blood smear had spherocytes and biochemical values showed high bilirubin and LDH. Immunohematological work up revelaed polyspecific DAT was negative but monospecific DAT screening showed strong (4+) positivity for IgA and a weak IgG positivity. The patient was diagnosed as IgA-mediated Warm AIHA and was started on prednisolone at 2 mg/kg/day following which hemoglobin improved over the next 2 months. After 2 weeks, prednisolone was tapered and stopped by the end of 3 months. Patients with clinical and laboratory evidence of acute hemolysis, an additional screening for IgA antibody may be done even in cases where poly-specific DAT is negative. Early detection helps in avoiding further investigations and provide efficient management.
Collapse
Affiliation(s)
- Nita Radhakrishnan
- Department of Paediatric Hemato-Oncology, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute (SSPH & PGTI), Noida, UP, India
| | - Seema Dua
- Department of Transfusion Medicine, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute (SSPH & PGTI), Noida, UP, India
| | - Satyam Arora
- Department of Transfusion Medicine, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute (SSPH & PGTI), Noida, UP, India.
| |
Collapse
|
2
|
Geel JA, Chirwa TC, Rowe B, Eyal KC, Omar F, Stones DK, Goga Y, Stefan DC, van Zyl A, Van Emmenes B, Wedi O, Vaithilingum M, Hendricks MG. Treatment outcomes of children with Hodgkin lymphoma between 2000 and 2010: First report by the South African Children's Cancer Study Group. Pediatr Blood Cancer 2017; 64. [PMID: 28383768 DOI: 10.1002/pbc.26536] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/11/2017] [Accepted: 02/16/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with Hodgkin lymphoma (HL) have excellent survival rates in high-income countries, but there are minimal outcome data in South African patients. Differing approaches to treatment are used in centres across South Africa, and the South African Children's Cancer Study Group (SACCSG) embarked on a programme to audit outcomes to improve survival rates. PATIENTS AND METHODS A multicentre study was conducted to analyse outcomes and prognostic factors of children with HL in South Africa. Ten dedicated South African paediatric oncology units participated in a retrospective data review. All patients with HL treated consecutively between January 2000 and December 2010 were included. Kaplan-Meier curves and Cox regression model were employed to determine survival rates and prognostic factors. RESULTS Two hundred and ninety-four patients were eligible for inclusion. The median age at presentation was 9.6 years (range 2.9-18.8); 55.4% of the patients presented with Stage III and IV disease and 9.9% were human immunodeficiency virus (HIV) positive. First-line therapy consisted of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) in 158 patients, vincristine, procarbazine/etoposide, prednisone and doxorubicin in 97 and adriamycin, bleomycin, vincristine and dacarbazine-chlorambucil, vinblastine, prednisone and procarbazine in 23 patients. The 5-year overall survival (OS) was 79% (95% confidence interval 73-84%). Multivariate analysis demonstrated that HIV infection (P = 0.018) and Ann Arbor Stage III and IV disease (P = 0.006) conferred a poor prognosis, while treatment with ABVD was associated with higher survival rates (P = 0.028). CONCLUSION OS rates are encouraging for a middle-income country, although economic disparities continue to impact negatively on outcomes. Study results will form the basis for the development of national protocol and continued advocacy to rectify disparities.
Collapse
Affiliation(s)
- Jennifer A Geel
- Faculty of Health Sciences, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Tobias C Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Biance Rowe
- Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Katherine C Eyal
- Faculty of Economics, University of Cape Town, Cape Town, South Africa
| | - Fareed Omar
- Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - David K Stones
- Faculty of Health Sciences, University of the Free State, Universitas Hospital, Bloemfontein, South Africa
| | - Yasmin Goga
- Faculty of Health Sciences, University of Kwazulu-Natal, Inkosi Albert Luthuli Hospital, Durban, South Africa
| | | | - Anel van Zyl
- Faculty of Health Sciences, University of Stellenbosch, Tygerberg Hospital, Tygerberg, South Africa
| | - Barry Van Emmenes
- Divison of Paediatric Haemetology and Oncology, Frere Hospital, East London, South Africa
| | - Oloko Wedi
- Divison of Paediatric Haemetology and Oncology, Polokwane-Mankweng Hospital Complex, Polokwane, South Africa
| | | | - Marc G Hendricks
- Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | |
Collapse
|
3
|
Fetzko S, Ahmed A, Cooling L. Finding the elusive and causative autoantibody: An atypical case of autoimmune hemolytic anemia. Clin Case Rep 2015; 3:227-30. [PMID: 25914813 PMCID: PMC4405306 DOI: 10.1002/ccr3.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 10/13/2014] [Accepted: 12/07/2014] [Indexed: 11/08/2022] Open
Abstract
An isolated IgA-mediated autoimmune hemolytic anemia can present a diagnostic challenge. When a routine direct antiglobulin test (DAT) is negative but clinical suspicion remains high, further testing with monospecific antisera should be performed. As with IgG-mediated WAIHA, steroids are first-line treatment, though splenectomy is often required to achieve a durable treatment response.
Collapse
Affiliation(s)
- Stephanie Fetzko
- Internal Medicine and Pediatrics Residency Program, University of Michigan Health System3116 Taubman Center, SPC 5368, 1500 E. Medical Center Drive, Ann Arbor, Michigan, 48198
| | - Asra Ahmed
- Department of Hematology and Oncology, University of Michigan Health SystemAnn Arbor, Michigan
| | - Laura Cooling
- Department of Pathology, University of Michigan Health SystemAnn Arbor, Michigan
- Blood Bank and Transfusion Services, University of Michigan Health SystemsAnn Arbor, Michigan
| |
Collapse
|
4
|
Hurtado-Cordovi JM, Verma V, Gotlieb V, Frieri M. Lymphocyte Rich Hodgkin's Lymphoma Presented with Warm Hemolytic Anemia: A Case Report and Literature Review. Case Rep Hematol 2011; 2011:385408. [PMID: 22937306 PMCID: PMC3420746 DOI: 10.1155/2011/385408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 07/13/2011] [Indexed: 01/20/2023] Open
Abstract
Hodgkin's lymphoma accounts for ten percent of all lymphomas. In the United States, there are about 8000 new cases every year. This paper describes a case of lymphocyte-rich Hodgkin's lymphoma (LRHL) manifested by autoimmune hemolytic anemia (AIHA). A 27-year-old Israeli male presented with dizziness associated with one month of low-grade fevers and night sweats; he also complained of persistent cough, pruritus, and ten-pound weight lost during this time. The CBC revealed hemoglobin of 5.9 gm/dL, and direct Coomb's test detected multiple nonspecific antibodies consistent with the diagnosis of AIHA. Chest, abdomen, and pelvic CT scan showed mediastinal lymphadenopathy and splenomegaly. Lymph node biopsy revealed classic LRHL. AIHA resolved after completion of the first cycle of chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD); after six cycles, he went into complete remission. Although infrequent, AIHA can be responsible for the presenting symptoms of HL.
Collapse
Affiliation(s)
- Jorge M Hurtado-Cordovi
- Divisions of Hematology and Oncology and Allergy and Immunology, Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
| | | | | | | |
Collapse
|