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Hirschman L, Munchel A. Case of Hemolytic Disease of the Fetus and Newborn Treated Without Blood Products. J Pediatr Hematol Oncol 2024; 46:e118-e120. [PMID: 38032187 DOI: 10.1097/mph.0000000000002795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
Hemolytic disease of the fetus and newborn (HDFN) affects 3/100,000 to 80/100,000 patients yearly and can cause severe anemia and hyperbilirubinemia. Recombinant human erythropoietin has been used as an adjunct therapy in patients with HDFN and hypo-regenerative anemia in the setting of receiving intrauterine blood transfusions. This case describes a patient with HDFN, in which the family were Jehovah Witnesses, and blood transfusions were declined. The patient had symptomatic anemia with a hematocrit nadir of 18.6%. The patient was successfully treated with recombinant human erythropoietin, ferrous sulfate, and folic acid, avoiding the need for transfusion.
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Affiliation(s)
- Leah Hirschman
- University of Maryland Children's Hospital, Department of Pediatrics Baltimore, MD, 21201, Unites States
| | - Ashley Munchel
- Department of Pediatric, Hematology/Oncology, University of Maryland Children's Hospital, Baltimore, MD
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Sevuk Ozumut SH, Turhan AB. Neonatal hemolytic disease: How should we use indirect and direct antiglobulin tests? Pediatr Neonatol 2024; 65:11-16. [PMID: 37414722 DOI: 10.1016/j.pedneo.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/22/2023] [Accepted: 05/19/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND In newborns with hemolysis, the direct antiglobulin test (DAT) and indirect antiglobulin test (IAT) play a key role in demonstrating the presence of an immune cause. We aimed to emphasize the importance of IAT in mothers of DAT-positive babies. METHODS DAT was performed with forward blood grouping on cord blood in term babies who were born between September 2020 and September 2022. IAT was performed in the mothers of the babies who were found to have a positive DAT and antibody identification was performed in the mothers who were found to have a positive IAT. Specific antibodies detected and identified were associated with the clinical course. RESULTS The study included 2769 babies and their mothers. The prevalence of DAT positivity was found to be 3.3% (87 of 2661). In DAT-positive babies, the rate of ABO incompatibility was 45.9%, the rate of RhD incompatibility was 5.7% and the rate of RhD and ABO incompatibility in association was 10.3%. The rate of subgroup incompatibility and other red blood cell antibodies was 18.3%. Phototherapy was applied because of indirect hyperbilirubinemia in 16.6% of the DAT-negative babies and in 51.5% of the DAT-positive babies. The need for phototherapy was significantly higher in DAT-positive infants (p < 0.01). Severe hemolytic disease of the newborn, bilirubin level, duration of phototherapy and use of intravenous immunoglobulin were found to be significantly higher in the babies whose mothers were IAT positive compared with the babies whose mothers were IAT negative (p < 0.01). CONCLUSIONS IAT should be performed on all pregnant women. When screening with IAT is not performed during pregnancy, performing DAT in the baby plays a key role. We showed that the clinical course was more severe when mothers of DAT-positive babies were IAT positive.
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Affiliation(s)
- Sibel H Sevuk Ozumut
- Pediatrics Department, Neonatology Division, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey.
| | - Ayse Bozkurt Turhan
- Blood Transfusion Center, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Kadikoy, Istanbul, Turkey
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Xu C, Bao Y, He Y, Wu M, Zhu J. Risk factors for readmission for hyperbilirubinemia in neonates with ABO hemolytic disease: a single-center retrospective cohort study. J Matern Fetal Neonatal Med 2023; 36:2238106. [PMID: 37487760 DOI: 10.1080/14767058.2023.2238106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE ABO hemolytic disease of the newborn (ABO-HDN) is a major risk factor for severe hyperbilirubinemia, a common readmission reason for newborns. In this study, we aimed to assess the risk factors for readmission associated with hyperbilirubinemia in neonates with ABO-HDN. METHODS A retrospective cohort study was conducted including newborns with gestational age ≥35 weeks and ABO-HDN in 2018. Among 291 newborns, 36 were readmitted for hyperbilirubinemia and defined as the readmission group. The remaining 255 cases were used as a control group. We then performed between-group comparisons of clinical conditions associated with hyperbilirubinemia. Logistic regression was used to select risk predictors of readmission associated with hyperbilirubinemia due to ABO-HDN. RESULTS Baseline characteristics were similar between both groups (p > .05, respectively). However, total serum bilirubin (TSB) before initiating phototherapy was significantly higher in the readmission group when compared with that in the control group at 0-24 h, 24-48 h, and 48-72 h (183.70 µmol/L [interquartile range (IQR) 161.18-196.48] vs. 150.35 µmol/L [IQR 131.73-175.38], p = .005; 229.90 µmol/L [IQR 212.45-284.30] vs. 212.50 µmol/L [IQR 197.85-230.28], p = .026; 268.10 µmol/L [IQR 257.70-279.05] vs. 249.50 µmol/L [IQR 236.80-268.70], p = .045, respectively). The age of initiation of phototherapy in the readmission group was significantly lower than that in control group (30.0 h [IQR 18.0-49.00] vs. 42.0 h [IQR 23.0-61.0], p = .012). The rate of rebound hyperbilirubinemia after the first phototherapy treatment was significantly higher in the readmission group compared to that in the control group (9 [25%] vs. 13 [5.1%], p = .000), and the rate of positive direct antiglobulin testing was significantly higher than that in control group (17 [47.2%] vs. 74 [29.0%], p = .027). Logistic regression analysis showed that the age of initiation of photography, TSB level before the first phototherapy, and rebound hyperbilirubinemia after first phototherapy were independent risk factors for readmission in newborns with hyperbilirubinemia associated with ABO-HDN. CONCLUSIONS Earlier age of phototherapy initiation, higher TSB levels at the time of initiating phototherapy and rebound hyperbilirubinemia after the first phototherapy treatment may increase the risk of readmission for hyperbilirubinemia in neonates with ABO-HDN. These factors should be considered in discharge planning and follow-up for newborns with ABO-HDN associated hyperbilirubinemia.
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Affiliation(s)
- Chuncai Xu
- Department of Neonatology, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yingying Bao
- Department of Neonatology, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yuanyuan He
- Department of Neonatology, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Mingyuan Wu
- Department of Neonatology, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jiajun Zhu
- Department of Neonatology, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
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Thant M, Cancelas J, Kaplan A. The enhanced direct antiglobulin test in current practice has a limited impact on management of adult patients. Transfus Apher Sci 2023; 62:103768. [PMID: 37599155 DOI: 10.1016/j.transci.2023.103768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION The direct antiglobulin test (DAT) identifies immunoglobulin IgG and/or complement onthe red blood cell surface, allowing discrimination between immune and non-immunehemolysis. When the DAT is negative but there is clinical suspicion for immunehemolysis, an enhanced DAT can be sent to an immunohematology referencelaboratory (IRL). METHODOLOGY This retrospective study assessed the volume of enhanced DATs at a large tertiarycare center and evaluated their impact on patient care. Enhanced DATs were sent on21 adult patients (January 2019 - January 2021) at the University of Pittsburgh MedicalCenter and Allegheny Health Network. Laboratory and clinical data were collected andanalyzed. RESULTS Four out of 21 patients had positive tests (DAT and other serologic tests) at the localIRL. Enhanced DAT testing yielded positive results in an additional 5 patients butnegative or invalid results for 2 patients. High-dose steroid therapy was started in 12patients prior to receipt of enhanced DAT results. Enhanced DAT testing was sent amedian of 5 days after initiation of steroid therapy. For the patients trialed on steroids,the enhanced DAT results impacted medical decision-making in only 3 patients, and inonly one of those patients was the enhanced DAT positive despite a negative DAT at alocal IRL. In the non-steroid treated patients, enhanced DAT results did not contributeto clinical decision-making. CONCLUSION Enhanced DATs generally did not impact medical decision-making in adults withhemolytic anemia.
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Affiliation(s)
- Mamie Thant
- University of Pittsburgh, Pittsburgh, PA, USA; The Vontz Center for Molecular Studies, Division of Hematology-Oncology, 3125 Eden Avenue, ML 0562, Cincinnati, OH 45267, USA
| | - Jose Cancelas
- Hoxworth Blood Center, University of Cincinnati, 3130 Highland Ave., Cincinnati, OH 45219, USA
| | - Alesia Kaplan
- Department of Pathology, University of Pittsburgh Medical Center, Vitalant, Northeast Division, 3636 Blvd of the Allies, Pittsburgh, PA 15213, USA.
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Quraishy N, Sapatnekar S. Immunohematological testing and transfusion management of the prenatal patient. Adv Clin Chem 2023; 117:163-208. [PMID: 37973319 DOI: 10.1016/bs.acc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The primary indication for immunohematological testing in the prenatal patient is to detect and identify maternal red cell antibodies. If there are antibodies that are expected to hemolyze the fetus' red cells, their strength of reactivity must be tested, and the fetus' antigen status determined. After delivery, testing is performed to assess the extent of fetomaternal hemorrhage, as a large hemorrhage may require other therapeutic interventions. Another major role for immunohematological testing is to select blood components appropriately when intrauterine transfusion is required for fetal anemia resulting from maternal alloimmunization or some other cause. Supplementation with molecular methods has transformed the practice of immunohematology, particularly as it applies to typing for the D antigen of the Rh blood group system. Notwithstanding the advances in testing, close coordination and communication between the transfusion service and the obstetrics service are the foundation for ensuring the finest care for prenatal patients, and for new mothers and their infants. This review describes testing and transfusion practices for prenatal patients, using case presentations to highlight the management of selected immunohematological findings. It also includes a discussion of key patient management topics that are currently unresolved.
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Affiliation(s)
- NurJehan Quraishy
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Suneeti Sapatnekar
- Section of Transfusion Medicine, Department of Laboratory Medicine, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States.
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Al-Omran AM, Shapan HA, Al-Abdi SY. A retrospective comparison of phototherapy need in O-B versus O-A incompatibility in a single Saudi institution. J Neonatal Perinatal Med 2023:NPM221136. [PMID: 37182846 DOI: 10.3233/npm-221136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND ABO incompatibility is a major risk factor for neonatal indirect hyperbilirubinemia (NIH), requiring treatment. It has been shown that there are racial differences in direct antiglobulin test (DAT) positivity and phototherapy need in the O--B versus (vs) O--A incompatibility. The comparison between the O--B and O--A incompatibility is not well studied in Saudi Arabia. AIMS We aimed to compare DAT positivity and phototherapy need in O-B vs O-A incompatibility in Saudi Arabia. METHODS This retrospective cohort study was conducted in one Saudi hospital. We included a convenience sample of neonates born between 01 January 2013 and 31 December 2021. We included healthy neonates admitted to the nursery care unit only, born at≥38 weeks gestation, and had normal G6PD levels. Neonates that had no G6PD level measurement or lost follow-up post-discharge were excluded. The data span was the first 14 days of life. RESULTS A total of 611 neonates met our inclusion criteria. Positive DAT was more prevalent in the O-B than the O-A incompatibility [43.5% vs 29.2%, p < 0.001). A greater odd of phototherapy need was observed in the O--B vs O-A incompatibility across various strata. Readmission for NIH, use of 360° exposure phototherapy, or intravenous immunoglobulin administration was more prevalent in the O-B than the O-A incompatibility (13.2% vs 5.0%, p < 0.001). A logistic regression analysis revealed that the O-B incompatibility modified the association between DAT positivity and phototherapy need. CONCLUSIONS The O-B incompatibility had a mediator effect on the relationship between DAT positivity and the need for phototherapy in the study population, which emphasizes that the O-B and O-A are not the same from the NIH point of view.
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Affiliation(s)
- A M Al-Omran
- Department of Pediatrics, Almana General Hospital, Al-Ahsa, Saudi Arabia
| | - H A Shapan
- Department of Pediatrics, Almana General Hospital, Al-Ahsa, Saudi Arabia
| | - S Y Al-Abdi
- Department of Pediatrics, King Abdulaziz Hospital, Ministry of National Guard Hospital, Al-Ahsa, Saudi Arabia
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Salim H, Musmar B, A Sarhan FM, Giacaman N, Abu Omar S. The First-Reported Case of Drug-Induced Hemolytic Anemia by Piperacillin-Tazobactam in a Premature Neonate: A Case Report and Literature Review. Cureus 2023; 15:e35915. [PMID: 37038577 PMCID: PMC10082334 DOI: 10.7759/cureus.35915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
Drugs can have a wide array of effects on hematological cells, including red blood cells (RBCs), white blood cells (WBCs), and platelets. Drug-induced hemolytic anemia (DIHA) can be explained by three different pathophysiological mechanisms. We present a case of a premature neonate born at 34 weeks gestation who was admitted to the neonatal intensive care unit (NICU). He developed respiratory difficulty with mottled skin and was suspected to have bacterial sepsis due to necrotizing enterocolitis (NEC). The patient was eventually started on a broad-spectrum antibiotic, piperacillin-tazobactam. On day eight, the patient started developing jaundice and his hemoglobin level dropped from 12.1 to 8.2 mg/dL. His direct antiglobulin test (DAT) was strongly positive. The patient was suspected to have DIHA. Piperacillin-tazobactam is a commonly used antibiotic for neonatal sepsis, but its potential to cause DIHA in neonates is not well-established. Our case highlights the importance of considering piperacillin-tazobactam as an unrecognized contributor to neonatal jaundice and a potential cause of DIHA in neonates. Further research is needed to explore the extent of its involvement in this condition. Physicians should be cautious when administering this drug to neonates and be aware of the possibility of hemolysis and jaundice.
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Watchko JF. ABO hemolytic disease of the newborn: a need for clarity and consistency in diagnosis. J Perinatol 2023; 43:242-247. [PMID: 36344813 DOI: 10.1038/s41372-022-01556-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
Abstract
The diagnosis of ABO hemolytic disease of the newborn (ABO HDN) has been the subject of considerable debate and clinical confusion. Its use as an overarching default diagnosis for hyperbilirubinemia in all ABO incompatible neonates regardless of serological findings is problematic and lacks diagnostic precision. Data on hemolysis indexed by carbon monoxide (CO) levels in expired air (ETCOc) and blood (COHbc) support an essential role for a positive direct antiglobulin test (DAT) in making a more precise diagnosis of ABO HDN. A working definition that includes ABO incompatibility, significant neonatal hyperbilirubinemia, and a positive DAT is needed to gain clarity and consistency in the diagnosis of ABO HDN. Absent a positive DAT, the diagnosis of ABO HDN is suspect. Instead, a negative DAT in a severely hyperbilirubinemic ABO incompatible neonate should trigger an exhaustive search for an alternative cause, a search that may require the use of targeted gene panels.
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Affiliation(s)
- Jon F Watchko
- Professor Emeritus, Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Jacobs JW, Adkins BD, Woo JS, Stephens LD, Booth GS. Alemtuzumab and autoimmune haemolytic anaemia: Coincidence or causation? Vox Sang 2023; 118:257-259. [PMID: 36683306 DOI: 10.1111/vox.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023]
Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brian D Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis, University of Texas Southwestern, Dallas, Texas, USA
| | - Jennifer S Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, California, USA
| | - Laura D Stephens
- Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Berentsen S, Fattizzo B, Barcellini W. The choice of new treatments in autoimmune hemolytic anemia: how to pick from the basket? Front Immunol 2023; 14:1180509. [PMID: 37168855 PMCID: PMC10165002 DOI: 10.3389/fimmu.2023.1180509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
Autoimmune hemolytic anemia (AIHA) is defined by increased erythrocyte turnover mediated by autoimmune mechanisms. While corticosteroids remain first-line therapy in most cases of warm-antibody AIHA, cold agglutinin disease is treated by targeting the underlying clonal B-cell proliferation or the classical complement activation pathway. Several new established or investigational drugs and treatment regimens have appeared during the last 1-2 decades, resulting in an improvement of therapy options but also raising challenges on how to select the best treatment in individual patients. In severe warm-antibody AIHA, there is evidence for the upfront addition of rituximab to prednisolone in the first line. Novel agents targeting B-cells, extravascular hemolysis, or removing IgG will offer further options in the acute and relapsed/refractory settings. In cold agglutinin disease, the development of complement inhibitors and B-cell targeting agents makes it possible to individualize therapy, based on the disease profile and patient characteristics. For most AIHAs, the optimal treatment remains to be found, and there is still a need for more evidence-based therapies. Therefore, prospective clinical trials should be encouraged.
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Affiliation(s)
- Sigbjørn Berentsen
- Department of Research and Innovation, Haugesund Hospital, Helse Fonna Hospital Trust, Haugesund, Norway
- *Correspondence: Sigbjørn Berentsen,
| | - Bruno Fattizzo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, and Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Wilma Barcellini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Guillaume L, Chapelle V, Peeraer S, Streel C, Deneys V. Biological investigations of transfusion reactions: contribution of symptom-based decisional algorithms. Transfus Clin Biol 2022; 30:195-204. [PMID: 36273773 DOI: 10.1016/j.tracli.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/16/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES While transfusion is a common and safe therapeutic procedure in health care facilities, transfusion reactions can occur, whether acute or delayed, mild or life-threatening. In face of these reactions, the biological analysis laboratory plays a central role in their diagnosis. The objective of this article is to develop decisional algorithms for laboratory tests to be performed according to the clinical symptoms developed by the patient during or after transfusion. METHODS Based on the information collected by reviewing the literature and the procedures used in our hospital, we then developed biological investigation algorithms according to the symptoms presented by the patient, rather than the presumed reaction. RESULTS AND CONCLUSION We have developed symptom-based algorithms for acute transfusion reactions management that streamline laboratory testing and simplify the differential diagnosis.
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Schnieders E, Leon J, Chapman JM, Knudson CM. Patient ABO blood type is a major predictor of a positive DAT following a transfusion reaction. Transfusion 2022; 62:1715-1719. [PMID: 35836408 DOI: 10.1111/trf.17019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/03/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A direct antiglobulin test (DAT) checks for antibody or complement on the surface of RBCs and is often done following a transfusion reaction. While passive anti-A and anti-B antibodies are known to cause positive DATs, the extent this occurs following transfusion is unknown. STUDY DESIGN AND METHODS DAT results, ABO type, eluate information, and blood product information were recorded on 1097 transfusion reactions at a large academic hospital over 8 years. The effect of patient blood type, product type, and plasma compatibility of blood product transfused on DAT results were determined. Statistical significance was determined using Chi-squared testing. RESULTS Patient ABO blood type was a strong predictor of a positive DAT, with type O patients having 6.7% positive rate and non-O patients having a positive rate of 20.6% (p < .0001). Plasma compatibility of the product was a strong predictor of a positive DAT, with plasma compatible transfusions having a 9.4% positive rate while plasma incompatible transfusions were positive 44% of the time (p < .0001). Elution studies found that anti-A/B antibodies were the most common antibody identified. Platelets were more likely to be associated with a positive DAT when compared with RBC transfusions (p < .05). CONCLUSIONS These results demonstrate the patient ABO type and plasma incompatibility are strong predictors of positive DAT results following a transfusion reaction. Anti-A and anti-B antibodies are estimated to account for about 50% of positive DATs in this study.
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Affiliation(s)
- Eric Schnieders
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Judith Leon
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - James M Chapman
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - C Michael Knudson
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
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Ishii H, Sato T, Ishibashi M, Yokoyama H, Saito T, Tasaki T, Yano S. A case of immune complex type hemolytic anemia by initial micafungin administration. Int J Infect Dis 2022; 122:755-757. [PMID: 35840096 DOI: 10.1016/j.ijid.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
We report the first case of immune complex type hemolytic anemia by initial micafungin administration that was given as prophylaxis to a 42-year-old Japanese man receiving chemotherapy for primary amyloidosis. The few cases found in the literature were associated with secondary administration to cause immune hemolysis attacks. Despite its rarity, the present case calls for increased awareness of micafungin-induced hemolytic anemia upon initial administration.
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Affiliation(s)
- Hiroto Ishii
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine.
| | - Tomohiko Sato
- Division of Transfusion Medicine and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Miyuki Ishibashi
- Division of Transfusion Medicine and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Hiroki Yokoyama
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Takeshi Saito
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Tetsunori Tasaki
- Division of Transfusion Medicine and Cell Therapy, The Jikei University Hospital, Tokyo, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine
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Kokoris SI, Kalantzis D, Moschandreou D, Papaioannou K, Grouzi E. Panagglutination on the indirect antiglobulin test... this is the challenge! Asian J Transfus Sci 2022; 16:257-262. [PMID: 36687552 PMCID: PMC9855219 DOI: 10.4103/ajts.ajts_133_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 01/25/2023] Open
Abstract
Panagglutination on the indirect antiglobulin test is one of the most challenging dilemmas of pretransfusion testing. It occurs when patient sera react with all red blood cells tested, that is, with both screening and identification panel cells. Two main questions must be answered. The first is to determine whether panagglutination results from the presence of autoantibody and/or alloantibody (single alloantibody or multiple alloantibodies or antibody to high-incidence antigen). The second problem is to detect the possible concomitant presence of clinically significant alloantibodies masked by panagglutination. The purpose of this mini-review is to describe the situations that can cause panagglutination and to develop algorithms which can resolve the problem. The two main points in the evaluation of panagglutination involve the assessment of the intensity of reactivity with the reagent red cells used and whether the autocontrol is positive or not. It is imperative to understand the laboratory results and the techniques available that guide the investigative process.
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Affiliation(s)
- Styliani I. Kokoris
- Laboratory of Hematology and Hospital Blood Transfusion Department, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Chaidari, Greece
| | - Dimitrios Kalantzis
- Laboratory of Hematology and Hospital Blood Transfusion Department, Medical School, University General Hospital 'Attikon', National and Kapodistrian University of Athens, Chaidari, Greece
| | - Dimitra Moschandreou
- Department of Transfusion Service and Clinical Hemostasis, 'Saint Savvas' Oncology Hospital, Athens, Greece
| | - Konstantina Papaioannou
- Department of Transfusion Service and Clinical Hemostasis, 'Saint Savvas' Oncology Hospital, Athens, Greece
| | - Elisavet Grouzi
- Department of Transfusion Service and Clinical Hemostasis, 'Saint Savvas' Oncology Hospital, Athens, Greece
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15
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Hafez W, Ziade MA, Arya A, Saleh H, Abdelrahman A. The significance of antiglobulin (Coombs) test reactivity in patients with COVID-19. Immunobiology 2022; 227:152240. [PMID: 35839729 PMCID: PMC9258419 DOI: 10.1016/j.imbio.2022.152240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/17/2022] [Accepted: 07/02/2022] [Indexed: 12/15/2022]
Abstract
Previous case reports have described patients with COVID-19-associated autoimmune hemolytic anemia (AIHA), and cold agglutinin disease (CAD) which is characterized by a positive direct antiglobulin (DAT) or "Coombs" test, yet the mechanism is not well understood. To investigate the significance of Coombs test reactivity among COVID-19 patients, we conducted a retrospective study on hospitalized COVID-19 patients treated at NMC Royal Hospital between 15 April and 30 May 2020. There were 27 (20%) patients in the Coombs-positive group and 108 (80%) in the Coombs-negative group. The cold agglutinin titer was examined in 22 patients due to symptoms suggestive of cold agglutinin disease, and all tested negative. We demonstrated a significant association with reactive Coombs test results in univariate analysis through clinical findings such as ICU admission rate, the severity of COVID-19, and several laboratory findings such as CRP, D-dimer, and hemoglobin levels lactate dehydrogenase, and RDW-CV. However, only hemoglobin levels and disease severity had a statistically significant association in multivariate analysis. A possible explanation of COVID-19-associated positive Coombs is cytokine storm-induced hyperinflammation, complement system activation, alterations of RBCs, binding of SARS-CoV-2 proteins to hemoglobin or its metabolites, and autoantibody production. Coombs-positive patients were tested for hemolysis using indirect bilirubin, consumed haptoglobin, and/or peripheral smear that ruled out any evidence of hemolysis. Understanding this etiology sheds new light on RBC involvement as a pathophysiological target for SARS-CoV-2 by interfering with their function; consequently, therapies capable of restoring RBC function, such as erythrocytapheresis, could be repurposed for the treatment of worsening severe and critical COVID-19.
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Affiliation(s)
- Wael Hafez
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Medical Research Division, Department of Internal Medicine, The National Research Center, Cairo, Egypt.
| | - Mohamad Azzam Ziade
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Arun Arya
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Husam Saleh
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Ahmed Abdelrahman
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates; Internal Medicine Department, Zagazig School of Medicine, Zagazig, Egypt
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16
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Abstract
Paroxysmal cold haemoglobinuria (PCH) accounts for around a third of cases of autoimmune haemolytic anaemia in children. PCH is caused by an autoantibody that fixes complement to red cells at low temperatures and dissociates at warmer temperatures (a biphasic haemolysin), triggering complement-mediated intravascular haemolysis. Named the Donath-Landsteiner (D-L) antibody after its discoverers, it is usually formed in response to infection and demonstrates specificity for the ubiquitous red cell P-antigen. A D-L test can be used to detect the presence of the D-L autoantibody in the patients' serum. Here we discuss the use of the D-L test in identifying PCH in a 2-year-old boy who presented with haemolytic anaemia. A summary of the key information can be found in the infographic.
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Affiliation(s)
| | - Ram K Jayaprakash
- Haematology, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, UK
| | - Heena Kithany
- Paediatrics, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, UK
| | - Mark Peter Tighe
- Paediatrics, University Hospitals Dorset NHS Foundation Trust, Poole, Dorset, UK
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17
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Mei C, Peng F, Yin W, Xu W, Yao R, Li B, Zhou R, Fan X, Li N. Increased suicidal erythrocyte death in patients with hepatitis B-related acute-on-chronic liver failure. Am J Physiol Gastrointest Liver Physiol 2022; 323:G9-G20. [PMID: 35411804 DOI: 10.1152/ajpgi.00050.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Anemia is a common complication of hepatitis B-related acute-on-chronic liver failure (HB-ACLF). Eryptosis, a suicidal erythrocyte death characterized by phosphatidylserine (PS) externalization and red blood cell-derived microparticle (RMP) generation, decreases erythrocyte lifespan. Herein, we investigated whether enhanced eryptosis is involved in the anemia pathophysiology associated with HB-ACLF. PS exposure, cell volume, cytosolic Ca2+, and reactive oxygen species (ROS) production were determined using flow cytometry. RMPs were extracted using a polyethylene glycol (PEG)-based method. We found that hemoglobin (Hb) and hematocrit (Hct) were significantly lower in patients with HB-ACLF than in healthy controls (HC), patients with chronic hepatitis B (CHB), and patients with cirrhosis. The direct antiglobulin test positive rate was 75.9% in patients with HB-ACLF while its intensity was associated with anemia. The ratio of abnormal erythrocytes was higher in patients with HB-ACLF than in HC, CHB, and cirrhosis. The percentage of PS-exposed erythrocytes was higher in patients with HB-ACLF (2.07 ± 0.11%) compared with HC (0.37 ± 0.05%), CHB (0.38 ± 0.03%), and cirrhosis (0.38 ± 0.04%). The cytosolic Ca2+ and ROS abundance were also higher in patients with HB-ACLF compared with HC, patients with CHB, and patients with cirrhosis, and were inversely correlated with the anemia in patients with HB-ACLF. PS exposure of erythrocytes collected from HC was significantly pronounced following incubation in plasma from patients with HB-ACLF compared with incubation in plasma from HC. The protein concentration and RMPs size significantly increased in patients with HB-ACLF compared with HC. Thus, the anemia in patients with HB-ACLF is associated with increased eryptosis, which is partially triggered by increased cytosolic Ca2+ and oxidative stress.NEW & NOTEWORTHY Acute chronic liver failure (ACLF) is a critical syndrome characterized by multiple organ failures and high short-term mortality. A common complication of HB-ACLF is anemia, however, the mechanism of anemia in HB-ACLF remains to be elucidated. We confirm that the accelerated eryptosis is involved in the pathophysiology of anemia associated with HB-ACLF, which progressively aggravates the clinical outcome. Our study illustrates the mechanism regarding the anemia pathogenesis of HB-ACLF, which may be utilized further toward therapeutic ends.
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Affiliation(s)
- Cheng Mei
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan, China
| | - Fang Peng
- Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenyu Yin
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan, China
| | - Wei Xu
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan, China
| | - Run Yao
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan, China
| | - Bijuan Li
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan, China
| | - Rongrong Zhou
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuegong Fan
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ning Li
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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18
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Yui JC, Brodsky RA. Updates in the Management of Warm Autoimmune Hemolytic Anemia. Hematol Oncol Clin North Am 2022; 36:325-339. [DOI: 10.1016/j.hoc.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Kerkar AS, Bhagwat SN, Sharma JH. A Study of Clinical and Serological Correlation of Positive Direct Antiglobulin Test in Blood Bank at a Tertiary Care Center. J Lab Physicians 2022; 14:223-230. [PMID: 36119425 PMCID: PMC9473924 DOI: 10.1055/s-0041-1741442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives
Detection of red cell bound immunoglobulins and/or complement by direct antiglobulin test (DAT) is a crucial serological assay in the diagnosis of autoimmune hemolytic anemia (AIHA). However, DAT may be positive in a variety of clinical conditions with or without hemolysis. We aimed at evaluating the clinical and serological correlation of positive DAT by categorizing the clinical conditions associated with positive DAT, estimating the presence of in vivo hemolysis in case of positive DAT with polyspecific and monospecific antisera and correlating the strength of positive DAT with the presence of hemolysis.
Materials and Methods
The prospective observational study was performed on 200 samples that were positive for DAT with polyspecific antiglobulin reagent as the baseline investigation. These samples were further tested with anti-immunoglobulin G and anti-C3 monospecific DAT reagents to evaluate the type of protein responsible for positive DAT. The antiglobulin tests were performed by tube technique. DAT positivity was graded (1+ to 4 + ) in each patient. Autocontrol test was included. The patients with positive polyspecific DAT were categorized into different clinical conditions. The presence or absence of in vivo hemolysis was evaluated in all clinical categories and also for each grade of positivity with polyspecific and monospecific antiglobulin reagents.
Statistical Analysis
Binomial logistic regression and Mann–Whitney
U
test were applied to between the group analyses. For categorical variables, Fisher's exact test and relative risk were used. The qualitative data were expressed in numbers and percentages.
Results
The highest number of patients (75/200, 37.5%) belonged to the autoimmune diseases group. Tuberculosis and hepatitis C were the main infectious diseases associated with positive DAT. Out of 200 DAT-positive patients, 98 (49%) had in vivo hemolysis and 102 (51%) did not have hemolysis. AIHA (22) and systemic lupus erythematosus (18) were the commonest clinical conditions associated with in vivo hemolysis. All the 11 samples that showed positivity with only anti-C3 reagent did not show any hemolysis. There was statistically significant increase in the incidence of in vivo hemolysis with increasing grades of DAT positivity with all the three antihuman globulin reagents.
Conclusion
There are different disease conditions which show positive DAT with or without hemolysis. So, it is important to clinically and serologically correlate positive DAT results.
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Affiliation(s)
- Alisha Suresh Kerkar
- Department of Transfusion Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Swarupa Nikhil Bhagwat
- Department of Transfusion Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Jayashree Harihara Sharma
- Department of Transfusion Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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20
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Dei Zotti F, Qiu A, La Carpia F, Moriconi C, Hudson KE. A New Murine Model of Primary Autoimmune Hemolytic Anemia (AIHA). Front Immunol 2021; 12:752330. [PMID: 34867985 PMCID: PMC8634489 DOI: 10.3389/fimmu.2021.752330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Loss of humoral tolerance to red blood cells (RBCs) can lead to autoimmune hemolytic anemia (AIHA), a severe, and sometimes fatal disease. Patients with AIHA present with pallor, fatigue, decreased hematocrit, and splenomegaly. While secondary AIHA is associated with lymphoproliferative disorders, infections, and more recently, as an adverse event secondary to cancer immunotherapy, the etiology of primary AIHA is unknown. Several therapeutic strategies are available; however, there are currently no licensed treatments for AIHA and few therapeutics offer treatment-free durable remission. Moreover, supportive care with RBC transfusions can be challenging as most autoantibodies are directed against ubiquitous RBC antigens; thus, virtually all RBC donor units are incompatible. Given the severity of AIHA and the lack of treatment options, understanding the cellular and molecular mechanisms that facilitate the breakdown in tolerance would provide insight into new therapeutics. Herein, we report a new murine model of primary AIHA that reflects the biology observed in patients with primary AIHA. Production of anti-erythrocyte autoantibodies correlated with sex and age, and led to RBC antigen modulation, complement fixation, and anemia, as determined by decreased hematocrit and hemoglobin values and increased reticulocytes in peripheral blood. Moreover, autoantibody-producing animals developed splenomegaly, with altered splenic architecture characterized by expanded white pulp areas and nearly diminished red pulp areas. Additional analysis suggested that compensatory extramedullary erythropoiesis occurred as there were increased frequencies of RBC progenitors detectable in the spleen. No significant correlations between AIHA onset and inflammatory status or microbiome were observed. To our knowledge, this is the first report of a murine model that replicates observations made in humans with idiopathic AIHA. Thus, this is a tractable murine model of AIHA that can serve as a platform to identify key cellular and molecular pathways that are compromised, thereby leading to autoantibody formation, as well as testing new therapeutics and management strategies.
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Affiliation(s)
- Flavia Dei Zotti
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, New York, NY, United States
| | - Annie Qiu
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, New York, NY, United States
| | - Francesca La Carpia
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, New York, NY, United States
| | - Chiara Moriconi
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, New York, NY, United States
| | - Krystalyn E Hudson
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, New York, NY, United States
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21
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Shelly J, Kull M. Autoimmune Hemolytic Anemia: A Case Study Presentation. Clin J Oncol Nurs 2021; 25:633-636. [PMID: 34800090 DOI: 10.1188/21.cjon.633-636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Autoimmune hemolytic anemia (AIHA) is a rare and potentially life-threatening condition. This article presents a case study of AIHA in a patient with a history of acute myelogenous leukemia in remission. Differentiating the cause and type of HA (extrinsic versus intrinsic) will be discussed, along with information on follow-up and refractory AIHA. Advanced practice RNs (APRNs) play an essential role in the early recognition of HA, as well as the diagnosis, referral, and management of the condition.
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22
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Alquist CR, Helander L. Transfusion Blood Bank (Recipient) Testing. Clin Lab Med 2021; 41:599-610. [PMID: 34689967 DOI: 10.1016/j.cll.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pretransfusion and post-transfusion recipient testing are routine blood bank functions. This article presents a review of request and sample requirements, routine and extended typing and antibody evaluation, and post-transfusion circumstances requiring additional work-up. Although the regimented approach of blood banking fundamentals may be viewed as tedious, these steps are defined and designed to prevent potentially fatal ABO-incompatible transfusions and improve the overall safety of transfusion medicine patients.
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Affiliation(s)
- Caroline R Alquist
- Hoxworth Blood Center Academic Unit and Department of Pathology & Laboratory Medicine, University of Cincinnati, 3130 Highland Avenue, Hoxworth Building, 5th Floor TID, Cincinnati, OH 45267, USA.
| | - Louise Helander
- Children's Hospital Colorado; Department of Medicine, University of Colorado, ClinImmune Labs, Bioscience 2, 12705 East Montview Boulevard, Suite 250, Aurora, CO 80011, USA
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23
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Cabo J, Brochier A, Saussoy P, van Dievoet MA, Capirchio L, Delire B, Deneys V. Positive direct antiglobulin test in COVID-19 patients: Decision-making process. Transfus Clin Biol 2021; 28:414-419. [PMID: 34111506 PMCID: PMC8183097 DOI: 10.1016/j.tracli.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 01/04/2023]
Abstract
In this unprecedented crisis of severe acute respiratory syndrome coronavirus 2 and its associated coronavirus disease 2019 (COVID-19), polymerase chain reaction and then serological testing platforms have been massively developed to face the important screening demand. Polymerase chain reaction and serological testing platforms are not the only actors impacted by the crisis, transfusion services are facing important difficulties. A positive direct antiglobulin test is frequently observed for patients encountering COVID-19. Patients with severe symptoms may develop anaemia and become good candidates for blood transfusions. The interpretation of a positive direct antiglobulin test for patients recently transfused and suffering from COVID-19 is complex. The differentiation between COVID-19 induced antibodies and possible associated transfusion alloantibodies is therefore crucial. In this context, the elution technique incorporated in an appropriate decision-making process plays its full role. This intricate topic is presented through a case report followed by literature review and finally decision-making process for COVID-19 patients necessitating red blood cells administration.
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Affiliation(s)
- J Cabo
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - A Brochier
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - P Saussoy
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - M-A van Dievoet
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - L Capirchio
- Gastroenterology department, Cliniques Universitaires St Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - B Delire
- Gastroenterology department, Cliniques Universitaires St Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - V Deneys
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
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24
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Crowe EP, Goel R, Andrews J, Meyer EK, Wong TE, Sloan SR, Delaney M, Lieberman L, Cushing MM. Survey of newborn direct antiglobulin testing practice in United States and Canadian transfusion services. Transfusion 2021; 61:1080-1092. [PMID: 33629748 DOI: 10.1111/trf.16335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND We hypothesized that variability in practice exists for newborn immunohematology testing due to lack of consensus guidelines. We report the results of a survey assessing that variability at hospitals in the United States and Canada. STUDY DESIGN AND METHODS An AABB Pediatric Subsection working party developed and validated a survey of newborn immunohematology testing practice. The survey was sent electronically to transfusion service leadership at teaching institutions. RESULTS The response rate was 67% (61/91); 56 surveys meeting inclusion criteria were analyzed. Approximately 90% (50/56) were from birth hospitals and 16.1% (9/56) were from pediatric hospitals. Newborn immunohematology testing is ordered as a panel by 66.0% (33/50) of birth hospitals. ABO group and DAT is mandated before discharge in 14/56 (25.0%) and 13/56 (23.2%), respectively. About 76.8% (43/56) selectively perform a DAT according to blood blank or clinical parameters. The most common DAT practices include anti-IgG only testing by 73.2% (41/56) and use of umbilical cord specimen type by 67.9% (38/56). A positive DAT is a critical value for 26.8% (15/56) and followed with eluate testing when a maternal antibody screen is positive for 48.2% (27/56). In the setting of a non-ABO maternal red cell antibody, 55.4% (31/56), phenotype neonatal red cells when the DAT is positive. Group O RBC are transfused irrespective of the DAT result for 82.1%, (46/56). CONCLUSION There is variability in newborn immunohematology testing and transfusion practice and potential overutilization of the DAT. Evidence-based consensus guidelines should be developed to standardize practice and to improve safety.
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Affiliation(s)
- Elizabeth P Crowe
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Hematology/Oncology, Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jennifer Andrews
- Department of Pediatrics and Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Erin K Meyer
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Trisha E Wong
- Pathology and Pediatric Hematology Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - Steven R Sloan
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meghan Delaney
- Pathology and Laboratory Medicine Division, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pathology & Pediatrics, The George Washington University Medical School, Washington, District of Columbia, USA
| | - Lani Lieberman
- University Health Network and Affiliated Hospitals, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melissa M Cushing
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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25
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Richards AL, Qiu A, Dei Zotti F, Sheldon K, Usaneerungrueng C, Gruber DR, Hudson KE. Autoantigen presentation by splenic dendritic cells is required for RBC-specific autoimmunity. Transfusion 2021; 61:225-235. [PMID: 33151564 PMCID: PMC9092285 DOI: 10.1111/trf.16191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 08/29/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Failure of humoral tolerance to red blood cell (RBC) antigens may lead to autoimmune hemolytic anemia (AIHA), a severe and sometimes fatal disease. Previous studies have shown that although tolerance is robust in HOD mice, autoantibodies are generated upon adoptive transfer of OTII CD4+ T cells, which are specific for an epitope contained within the HOD antigen. These data imply that antigen-presenting cells (APCs) are presenting RBC-derived autoantigen(s) and are capable of driving T-cell activation. Given that multiple APCs participate in erythrophagocytosis, we used a transgenic approach to determine which cellular subsets were required for autoantigen presentation and subsequent autoreactive T-cell activation. STUDY DESIGN AND METHODS HOD mice, which express an RBC-specific antigen consisting of hen egg lysozyme, ovalbumin, and human blood group molecule Duffy, were bred with IAbfl/fl and Cre-expressing transgenic animals to generate mice that lack I-Ab expression on particular cell subsets. OTII CD4+ T cell proliferation was assessed in vivo in HOD+ I-Abfl/fl xCre+ mice and in vitro upon coculture with sorted APCs. RESULTS Analysis of HOD+ I-Abfl/fl xCre+ mice demonstrated that splenic conventional dendritic cells (DCs), but not macrophages or monocytes, were required for autoantigen presentation to OTII CD4+ T cells. Subsequent in vitro coculture experiments revealed that both CD8+ and CD8- DC subsets participate in erythrophagocytosis, present RBC-derived autoantigen and stimulate autoreactive T-cell proliferation. CONCLUSION These data suggest that if erythrocyte T-cell tolerance fails, DCs are capable of initiating autoimmune responses. As such, targeting DCs may be a fruitful strategy for AIHA therapies.
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Affiliation(s)
| | - Annie Qiu
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Flavia Dei Zotti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | | | | | | | - Krystalyn E. Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
- KEH was at Bloodworks NW Research Institute prior to transitioning to Columbia University Irving Medical Center
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26
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Chetty T, Bouwer N, Wan YO, Mahlangu J. Immunoglobulin subtyping and quantification in direct antiglobulin test: positive haemolysis in an HIV-prevalent setting. J Clin Pathol 2020; 75:117-120. [PMID: 33328180 DOI: 10.1136/jclinpath-2020-207113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/04/2022]
Abstract
AIMS Positive direct antiglobulin tests (DATs) are valuable in identifying the aetiology of autoimmune haemolysis and in guiding therapeutic intervention. However, in HIV-positive individuals with background polyclonal gammopathy, a positive DAT in the absence of haemolysis is common. In this setting, IgG quantification and subtyping may be of value, as this is possible with the recently introduced gel cards. There is paucity of literature evaluating the diagnostic usefulness of IgG subtyping and quantification in HIV-positive individuals who are investigated for autoimmune haemolytic anaemia (AIHA). This study evaluated the usefulness of IgG quantification and subtyping in the diagnostic work-up of AIHA in patients with a positive DAT, with and without HIV infection. METHODS This retrospective, cross-sectional study included patients investigated for AIHA in a quaternary care hospital. Those with a positive DAT had their IgG subtyped and quantified using the ID-Card DAT IgG1/IgG3 and IgG-dilution cards (Bio-Rad, Cressier, Switzerland). RESULTS Ninety patients admitted from December 2019 to March 2020 were investigated for AIHA. Forty-four (49%) patients had a positive DAT of whom 26 (59%) had evidence of haemolysis, and 16 (36%) were HIV positive. Concurrent HIV and haemolysis were present in eight patients, two of whom had IgG1 although none had an IgG antibody titre >1:30. None of the HIV-positive patients without features of haemolysis had IgG1/IgG3 or IgG antibody titres >1:30. CONCLUSION In our clinical setting, IgG quantification and subtyping were found to be of limited value in the diagnostic characterisation of AIHA in HIV-positive patients with false-positive DAT.
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Affiliation(s)
- Thirosha Chetty
- Department of Molecular Medicine and Haematology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa .,Haematology, National Health Laboratory Service, Johannesburg, South Africa
| | - Nikki Bouwer
- Department of Molecular Medicine and Haematology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa.,Haematology, National Health Laboratory Service, Johannesburg, South Africa
| | - Yuen On Wan
- Southern Community Laboratories, and Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Johnny Mahlangu
- Department of Molecular Medicine and Haematology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa.,Haematology, National Health Laboratory Service, Johannesburg, South Africa
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Hamed K, Wiktorowicz T, Assadi Gehr M. No Evidence for Ceftobiprole-Induced Immune Hemolytic Anemia in Three Phase 3 Clinical Trials. Infect Drug Resist 2020; 13:3209-3215. [PMID: 32982335 PMCID: PMC7502402 DOI: 10.2147/idr.s268269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Drug-induced immune hemolytic anemia (DIIHA) is a rare but serious adverse event associated with a number of drugs, including second- and third-generation cephalosporins. A positive direct antiglobulin test (DAT) is a reliable finding in DIIHA, but positive results without evidence of hemolysis can occur, particularly in hospitalized patients. There have been no reports of hemolytic anemia in four previous Phase 3 trials or from post-marketing surveillance of the advanced-generation, broad-spectrum cephalosporin, ceftobiprole. The aim of this analysis was to review the incidence of positive DAT results and any evidence of hemolytic anemia from three recent Phase 3 trials of ceftobiprole. Patients and Methods Patients were enrolled in three Phase 3 randomized controlled trials: 94 pediatric patients with pneumonia received ceftobiprole in the BPR-PIP-002 trial; 335 adults with acute bacterial skin and skin structure infections received ceftobiprole in the TARGET trial; and 201 adults with Staphylococcus aureus bacteremia have been randomized 1:1 to ceftobiprole or daptomycin ± aztreonam in the ongoing ERADICATE trial. In all three trials, DAT results were obtained at baseline, and follow-up tests were performed either at the test of cure (TOC) visit (BPR-PIP-002), end-of-treatment (EOT) visit (TARGET), or both EOT and post-treatment Day 70 visits (ERADICATE). Results In the BPR-PIP-002 trial, five patients (all ceftobiprole treated) had a documented negative DAT result at baseline followed by a positive result at the TOC visit. One patient in the ongoing, blinded ERADICATE trial had a positive DAT result at both baseline and EOT. Results from other laboratory investigations showed no evidence of hemolytic anemia in these patients. No positive DAT results were reported in the TARGET trial. Conclusion No evidence of hemolytic anemia associated with ceftobiprole was observed in either adults or children across several indications in this analysis of three large Phase 3 trials.
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Affiliation(s)
- Kamal Hamed
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
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Wong ASL, Gruber DR, Richards AL, Sheldon K, Qiu A, Hay A, Hudson KE. Tolerization of recent thymic emigrants is required to prevent RBC-specific autoimmunity. J Autoimmun 2020; 114:102489. [PMID: 32507505 DOI: 10.1016/j.jaut.2020.102489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
Autoimmune hemolytic anemia (AIHA) leads to accelerated destruction of autologous red blood cells (RBCs) by autoantibodies. AIHA is a severe and sometimes fatal disease. While there are several therapeutic strategies available, there are currently no licensed treatments for AIHA and few therapeutics result in treatment-free durable remission. The etiology of primary AIHA is unknown; however, secondary AIHA occurs concurrently with lymphoproliferative disorders and infections. Additionally, AIHA is the second most common manifestation of primary immunodeficiency disorders and has been described as a side effect of checkpoint inhibitor therapy. Given the severity of AIHA and the lack of treatment options, understanding the initiation of autoimmunity is imperative. Herein, we utilized a well-described model of RBC biology to dissect how RBC-specific autoreactive T cells become educated against RBC autoantigens. We show that, unlike most autoantigens, T cells do not encounter RBC autoantigens in the thymus. Instead, when they leave the thymus as recent thymic emigrants (RTEs), they retain the ability to positively respond to RBC autoantigens; only after several weeks in circulation do RTEs become nonresponsive. Together, these data suggest that any disruption in this process would lead to breakdown of tolerance and initiation of autoimmunity. Thus, RTEs and this developmental process are potential targets to prevent and treat AIHA.
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Affiliation(s)
| | | | | | | | - Annie Qiu
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, New York, NY, USA
| | - Ariel Hay
- University of Virginia, Charlottesville, VA, USA
| | - Krystalyn E Hudson
- Columbia University Irving Medical Center, Department of Pathology and Cell Biology, New York, NY, USA.
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Korzh MO, Filipenko VA, Leontieva FS, Morozenko DV, Marushchak OP, Dielievska VY. A Case of Agglutination and Hemolysis of Erythrocytes Caused by the Patient’s Own Plasma. Acta Medica Bulgarica 2020; 47:50-5. [DOI: 10.2478/amb-2020-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of the work was to study the agglutination and hemolysis of erythrocytes under diff erent conditions in vitro in a patient with unknown cause of anemia and concomitant secondary instability of endoprosthesis.
Material and methods. One percent (1%) suspension of erythrocytes of a woman, 61 years old, A (II) Rh- (negative) presented with anemia was incubated with her serum and plasma at pH 7.3, pH 5.8 and 9.0, as well as with IgM α and β antibodies. Unithiol was used to destroy IgM antibodies. The samples were incubated for 12 hours at 37° C, and the presence of the agglutination and hemolysis was evaluated.
Results. The incubation of the plasma with unwashed erythrocytes of the patient led to the agglutination of the erythrocytes and the usage of the complement led to the hemolysis. After inactivation of IgM in the plasma the agglutination was absent and the hemolysis was present under usual conditions and at pH 5.8, whereas at pH 8.0 the hemolysis was attenuated, however a slight degree agglutination appeared. The usage of the complement led to the agglutination and the hemolysis, absent at pH 8.0. The plasma incubated with washed red blood cells and the complement led to the hemolysis. The incubation of the serum with washed erythrocytes led to the hemolysis at pH 5.8, attenuated after the usage of the complement. The contact of terbinophine with plasma and unwashed red blood cells led to the absence of both the hemolysis and the agglutination. Candida lusitaniae growth was detected in the plasma.
Conclusions. The agglutination of unwashed erythrocytes by own plasma, attenuated in the alkaline medium and enhanced in the acid medium, as well as the absence of the agglutination after the usage of terbinophine and the hemolysis in the presence of the complement might be the signs of mycogenic and autoimmune origin of anemia with the activation of autoimmune complement – binding antibodies.
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Roy S, Pathania M, Kant R, Dhar M, Amisha, Malik P, Rathaur VK. Common presentation of an uncommon anaemia in a resource-limited setting: A diagnostic challenge. J Family Med Prim Care 2019; 8:3766-3768. [PMID: 31803690 PMCID: PMC6881960 DOI: 10.4103/jfmpc.jfmpc_529_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 11/04/2022] Open
Abstract
A 38-year-old female in the reproductive age group presented with anaemia in a resource-poor setting. The patient was given multiple transfusions during the course of her treatment. After a proper work-up she was diagnosed with Coomb's negative autoimmune haemolytic anaemia (AIHA). She was later treated with steroid and she showed significant improvement. Early diagnosis in her case at the primary care level with other causes of anaemia in mind could have prevented unnecessary transfusions and morbidity. Proper history and approach to anaemia is the key in a resource-poor setting.
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Affiliation(s)
- Shankar Roy
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Monika Pathania
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Minakshi Dhar
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Amisha
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Paras Malik
- Department of Medicine, AIIMS, Rishikesh, Uttarakhand, India
| | - Vyas Kumar Rathaur
- Professor, KD Medical College Hospital and Research Institute, Mathura, Uttar Pradesh, India
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Brunetta DM, Barros Carlos LM, Da Silva VFP, Oliveira Alves TM, Macedo ÊS, Coelho GR, Vasconcelos JBM, De Francesco Daher E, Garcia JHP. Prospective evaluation of immune haemolysis in liver transplantation. Vox Sang 2019; 115:72-80. [DOI: 10.1111/vox.12865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Denise Menezes Brunetta
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Centro de Hematologia e Hemoterapia do Ceara Fortaleza Brazil
- Department of Surgery Universidade Federal do Ceara Fortaleza Brazil
| | | | | | | | - Ênio Simas Macedo
- Department of Internal Medicine Universidade Federal do Ceara Fortaleza Brazil
| | - Gustavo Rego Coelho
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Department of Surgery Universidade Federal do Ceara Fortaleza Brazil
| | | | - Elizabeth De Francesco Daher
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Department of Internal Medicine Universidade Federal do Ceara Fortaleza Brazil
| | - José Huygens Parente Garcia
- Hospital Universitario Walter Cantidio Fortaleza Brazil
- Department of Surgery Universidade Federal do Ceara Fortaleza Brazil
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MacNeill AL, Dandrieux J, Lubas G, Seelig D, Szladovits B. The utility of diagnostic tests for immune-mediated hemolytic anemia. Vet Clin Pathol 2019; 48 Suppl 1:7-16. [PMID: 31502273 DOI: 10.1111/vcp.12771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/13/2019] [Accepted: 06/02/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND A definitive diagnosis of immune-mediated hemolytic anemia (IMHA) can be difficult to make. However, it is critical to differentiate IMHA from other causes of anemia due to the impact on prognosis and outcome for IMHA patients. Recently published American College of Veterinary Internal Medicine recommendations for the diagnosis of IMHA should be followed to concurrently confirm ongoing anemia, verify in vivo hemolysis, and detect anti-erythrocyte antibodies. The reliability of immunologic IMHA tests varies depending on which test is used and how it is performed. OBJECTIVES Our aims were to determine which tests are currently used in veterinary medicine to diagnose IMHA and review the utility of assays that have historically been used to diagnose IMHA. METHODS A short survey was designed to see which diagnostic tests for IMHA were currently being used by veterinary practices. The survey was distributed via list-serves to veterinarians and veterinary technologists. A literature review was performed to report the utility of diagnostic tests for the diagnosis of IMHA. RESULTS Survey respondents indicated a variability in test protocols used to diagnose IMHA. Most respondents perform saline agglutination or Coombs' tests to detect anti-erythrocyte antibodies. Additional tests that can be used to support a diagnosis of IMHA are discussed in this review. CONCLUSIONS A standardized diagnostic approach should be followed to differentiate IMHA from other causes of anemia. Test methodology can vary from one laboratory to another, and clinicians should be familiar with the procedures used by their laboratory.
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Affiliation(s)
| | - Amy L MacNeill
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Julien Dandrieux
- Faculty of Veterinary and Agricultural Sciences, Translational Research and Animal Clinical Trial Study (TRACTS) Group, The University of Melbourne, Werribee, Vic., Australia
| | - George Lubas
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Davis Seelig
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA
| | - Balázs Szladovits
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, University of London, Hertfordshire, UK
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Khaled MB, Ouederni M, Sahli N, Dhouib N, Abdelaziz AB, Rekaya S, Kouki R, Kaabi H, Slama H, Mellouli F, Bejaoui M. Predictors of autoimmune hemolytic anemia in beta-thalassemia patients with underlying red blood cells autoantibodies. Blood Cells Mol Dis 2019; 79:102342. [PMID: 31302454 DOI: 10.1016/j.bcmd.2019.102342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 06/28/2019] [Indexed: 01/19/2023]
Abstract
In beta-thalassemia patients, erythrocyte autoantibodies can remain silent or lead to Autoimmune Hemolytic Anemia (AIHA).The aim of this study was to identify predictors of AIHA in beta-thalassemia patients with positive Direct Antiglobulin Test (DAT), in Tunisia. This longitudinal prognosis study was carried out on beta-thalassemia patients with a positive confirmed DAT. Predictors of AIHA were identified the Kaplan-Meier method. A Cox model analysis was used to identify independent predictors. Among 385 beta thalassemia patients, 87 developed positive DAT (22.6%). Autoimmune hemolytic anemia was occurred in 25 patients. Multivariate analysis showed that AIHA was independently associated with beta-thalassemia intermedia and similar family history of AIHA. Splenectomy in patients with positive DAT was independently associated with an increased risk of AIHA (HR = 6.175, CI: 2.049-18.612, p < 0.001). The risk of developing AIHA was higher during the first 72 transfusions. Autoimmune hemolytic anemia was significantly associated with polyspecific DAT (anti-complement and anti-IgG), blood group AB and prior alloimmunization. Whereas transfusion by phenotypic and leukoreduced blood was a protective factor. In summary, splenectomy after autoimmunization, prior alloimmunization, DAT specificity (IgG with complement), thalassemia intermedia, AB blood group and family history of AIHA were strongly associated with AIHA. Leukoreduced blood transfusion had a proven preventive role.
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Affiliation(s)
- Monia Ben Khaled
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia.
| | - Monia Ouederni
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia
| | - Nessrine Sahli
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia
| | - Nawel Dhouib
- Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia
| | | | - Samia Rekaya
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia
| | - Ridha Kouki
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia
| | - Houda Kaabi
- National Center of Blood Transfusion, Tunis, Tunisia
| | - Hmida Slama
- National Center of Blood Transfusion, Tunis, Tunisia
| | - Fethi Mellouli
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia
| | - Mohamed Bejaoui
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center Tunis, Tunis, Tunisia
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Autoantibodies/blood
- Coombs Test
- Dyspnea/etiology
- Erythrocytes/immunology
- Female
- Hematologic Tests
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
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Affiliation(s)
- Corbin Eule
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Arjun Gupta
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - Srikanth Nagalla
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Abstract
In this report, we will review the various clinical and laboratory approaches to diagnosing immune thrombocytopenia (ITP), with a focus on its laboratory diagnosis. We will also summarize the results from a number of laboratories that have applied techniques to detect anti-platelet autoantibodies as diagnostic tests for ITP. Although there is considerable variability in methods among laboratories, there is general agreement that platelet autoantibody testing has a high specificity but low sensitivity. This suggests several possibilities: (1) the ideal test for ITP has yet to be developed, (2) current test methods need to be improved, or (3) ITP is the clinical expression of a variety of thrombocytopenic disorders with different underlying mechanisms. Even the clinical diagnosis of ITP is complex, and experienced clinicians do not always agree on whether a particular patient has ITP. Improvements in the diagnostic approach to ITP are necessary to improve the management of this disorder.
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Affiliation(s)
- John G. Kelton
- Michael G. DeGroote School of Medicine, Department of Medicine and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Initiative for Innovation in Healthcare, McMaster University, Hamilton, ON, Canada
| | - John R. Vrbensky
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Donald M. Arnold
- Michael G. DeGroote School of Medicine, Department of Medicine and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- McMaster Centre for Transfusion Research, Hamilton, ON, Canada; and
- Canadian Blood Services, Hamilton, ON, Canada
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Abstract
PURPOSE To raise awareness of cefotetan-induced hemolytic anemia, a known rare but serious side effect that occurred in 5 patients at our medical center. SUMMARY Five cases of cefotetan-induced hemolytic anemia, which presented over the period of a single year at our center, are described. In each case, hemolytic anemia was confirmed by testing for the presence of anti-cefotetan antibodies. Each case occurred approximately 1 to 2 weeks following exposure to the drug. All five patients survived. A brief review of drug-induced immune hemolytic anemia (DIIHA) is also discussed. CONCLUSION DIIHA may be difficult to distinguish from other causes of hemolytic anemia, but should be included in the differential in patients exposed to medications associated with DIIHA. Once suspected, antibody testing should be performed, and once diagnosed, further exposure should be avoided.
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Affiliation(s)
- Kathlyn Lim
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Hai Tran
- Department of Pharmacy, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Angela Hirai-Yang
- Department of Pharmacy, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Niyati Vakil
- Center for Drug Policy, Partners Healthcare, Somerville, MA, USA
| | - Gregory Marks
- Department of Pharmacy, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ellen Klapper
- Division of Transfusion Medicine, Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Abstract
Correct blood group typing is a prerequisite for transfusion. In most cases blood group determination is without problems; however, in individual cases various factors can complicate blood group determination and sometimes lead to confusing findings. For a better understanding the clinician should have basic knowledge of blood typing. Blood group determination usually covers the AB0 blood groups, Rhesus and Kell systems; in addition, a direct Coombs test and an antibody screening test for the detection of irregular antibodies in the recipient are performed. Confusion of patients, blood samples, results or preparations can lead to severe consequences due to incompatible transfusion and must be prevented. In this context, bedside blood type testing before transfusion is of utmost importance. Problems in laboratory analysis as well as patient-related factors, such as the existence of irregular antibodies against red blood cells can complicate the immunohematology diagnostics. Certain medications, such as daratumumab, lead to a significantly increased complexity in laboratory analyses. Massive transfusions can lead to chimerism with more than one population of circulating red blood cells. Hematopoetic stem cell transplantation can also lead to a change in blood groups as well as chimerism. In addition, there are various other rare causes that can result in difficulties in blood group determination, such as rare blood groups or rare disease-associated phenomena. In the case of problems in blood group determination, early and close cooperation with transfusion medicine is essential for the clinician.
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Affiliation(s)
- P Möhnle
- Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Klinik für Anaesthesiologie, Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland.
| | - A Humpe
- Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Klinik für Anaesthesiologie, Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
| | - G Wittmann
- Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Klinik für Anaesthesiologie, Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
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Qadri SM, Donkor DA, Yan M, Ning S, Branch DR, Seghatchian J, Sheffield WP. Red blood cells, still vital after all these years: Commentary on Canadian Blood Services' International Symposium 2017. Transfus Apher Sci 2018; 57:298-303. [PMID: 29691151 DOI: 10.1016/j.transci.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Canadian Blood Services (CBS), Canada's national blood transfusion service, has for many years sponsored an annual conference, for the education and awareness of interested participants, showcasing the latest evidence-based understanding of both basic science and clinical issues in transfusion medicine and science. The 15th iteration of this symposium took place September 9, 2017 and focused on some of the vital aspects of red blood cells (RBC), in line with the" 3Rs" concept, namely the provision of the Right red blood cell (RBC) product to the Right patient at the Right time. Presentations touched upon: the evolution of blood banking in North America; the monocyte monolayer assay as a predictor of post-transfusion hemolysis; hemoglobin-based oxygen carriers; RBC alloimmunization; serological approaches to complex RBC antibody problems; randomized clinical trials related to the age of stored RBC; RBC genotyping; pathophysiology, prevention and treatment of hemolytic disease of the fetus and newborn (HDFN); and testing and timing in perinatal serology. This commentary provides summaries of all speakers' presentations annotated with relevant references. Special thanks are due to all contributors for their praiseworthy approaches in sharing their experiences and knowledge on this interesting scientific/clinical and management theme.
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Affiliation(s)
- Syed M Qadri
- Centre for Innovation of Canadian Blood Services, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David A Donkor
- Centre for Innovation of Canadian Blood Services, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shuoyan Ning
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Donald R Branch
- Centre for Innovation of Canadian Blood Services, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, United Kingdom.
| | - William P Sheffield
- Centre for Innovation of Canadian Blood Services, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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Tsang M, Dahlin JL, Sundsted KK. 79-Year-Old Woman With Jaundice and Anemia. Mayo Clin Proc 2018; 93:381-385. [PMID: 29258683 DOI: 10.1016/j.mayocp.2017.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/13/2017] [Accepted: 03/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Mazie Tsang
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jayme L Dahlin
- Resident in Clinical Pathology, Brigham and Women's Hospital, Boston, MA
| | - Karna K Sundsted
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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Thiessen K, Kraleti S. Cephalexin-induced haemolytic anaemia: A case report. J Clin Pharm Ther 2017; 42:615-617. [DOI: 10.1111/jcpt.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- K. Thiessen
- University of Arkansas for Medical Sciences College of Pharmacy; Little Rock AR USA
| | - S. Kraleti
- Department of Family and Preventive Medicine; University of Arkansas for Medical Sciences; Little Rock AR USA
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Abstract
The direct antiglobulin test (DAT; sometimes referred to as the "Coombs" test) continues to be one of the most widely used assays in laboratory medicine. First described about 70 years ago, it is elegantly simple in design, yet it is widely complex in its applications and interpretations, and it is prone to false-positive and false-negative results. The overall objective of our review is to provide practicing pathologists with a guide to identify situations when the DAT is useful and to highlight disease-specific shortcomings as well as general pitfalls of the test. To accomplish these goals, this review will discuss the following: (1) the history of the DAT, (2) how the test is performed in the clinical laboratory, (3) clinical situations for its use, (4) its interpretation, and (5) the pitfalls associated with DAT assays, including causes of false positivity.
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Ziman A, Cohn C, Carey PM, Dunbar NM, Fung MK, Greinacher A, Stanworth S, Heddle NM, Delaney M. Warm-reactive (immunoglobulin G) autoantibodies and laboratory testing best practices: review of the literature and survey of current practice. Transfusion 2016; 57:463-477. [DOI: 10.1111/trf.13903] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/01/2016] [Accepted: 09/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine; University of California Los Angeles; Los Angeles California
| | - Claudia Cohn
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | - Patricia M. Carey
- Hoxworth Blood Center and Department of Pathology and Laboratory Medicine; University of Cincinnati; Ohio
| | - Nancy M. Dunbar
- Departments of Pathology and Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Mark K. Fung
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington Vermont
| | - Andreas Greinacher
- Department of Immunology and Transfusion Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Simon Stanworth
- National Health Service (NHS) Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, United Kingdom; the Radcliffe Department of Medicine, University of Oxford; Oxford United Kingdom
| | - Nancy M. Heddle
- Faculty of Health Sciences, Department of Medicine; , Canadian Blood Services, McMaster University, and Centre for Innovation; Hamilton Ontario Canada
| | - Meghan Delaney
- Bloodworks NW; Seattle Washington
- Department of Laboratory Medicine; University of Washington; Seattle Washington
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Abstract
Autoimmune hemolytic anemia (AIHA) is a rare and heterogeneous disease that affects 1 to 3/100 000 patients per year. AIHA caused by warm autoantibodies (w-AIHA), ie, antibodies that react with their antigens on the red blood cell optimally at 37°C, is the most common type, comprising ∼70% to 80% of all adult cases and ∼50% of pediatric cases. About half of the w-AIHA cases are called primary because no specific etiology can be found, whereas the rest are secondary to other recognizable underlying disorders. This review will focus on the postulated immunopathogenetic mechanisms in idiopathic and secondary w-AIHA and report on the rare cases of direct antiglobulin test-negative AIHA, which are even more likely to be fatal because of inherent characteristics of the causative antibodies, as well as because of delays in diagnosis and initiation of appropriate treatment. Then, the characteristics of w-AIHA associated with genetically defined immune dysregulation disorders and special considerations on its management will be discussed. Finally, the standard treatment options and newer therapeutic approaches for this chronic autoimmune blood disorder will be reviewed.
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Affiliation(s)
- Theodosia A Kalfa
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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Lee BK, Le Ray I, Sun JY, Wikman A, Reilly M, Johansson S. Haemolytic and nonhaemolytic neonatal jaundice have different risk factor profiles. Acta Paediatr 2016; 105:1444-1450. [PMID: 27173507 DOI: 10.1111/apa.13470] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/19/2016] [Accepted: 05/10/2016] [Indexed: 12/23/2022]
Abstract
AIM This study examined maternal and pregnancy risk factors for haemolytic and nonhaemolytic neonatal jaundice in a large population-based cohort study. METHODS We conducted a cohort study of 1 019 220 singleton live births from the Swedish medical birth register from 1987 to 2002, using information on neonatal jaundice and maternal and pregnancy characteristics. Diagnoses of gestational hypertensive disorders were obtained by linkage to the national inpatient register. Multivariate logistic regression analysis provided odds ratios for the risk factors of both forms of jaundice. RESULTS A total of 6057 (0.6%) births were affected by haemolytic jaundice and 36 869 (3.6%) by nonhaemolytic jaundice. The strongest risk factors for haemolytic jaundice were maternal alloimmunisation, blood group O and neonatal jaundice in older siblings. For nonhaemolytic jaundice, the strongest risk factors were preterm birth, neonatal jaundice in older siblings, maternal origin from East or South-East Asia and maternal obesity. We estimated that 13% of haemolytic jaundice was attributable to alloimmunisation and 39% of nonhaemolytic jaundice was attributable to preterm birth. CONCLUSION Haemolytic and nonhaemolytic neonatal jaundice had different risk factor profiles. Interventions to reduce maternal alloimmunisation, preterm birth and maternal obesity may lower the prevalence of neonatal jaundice and the risk of consequent neurological complications.
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Affiliation(s)
- Brian K. Lee
- Department of Epidemiology and Biostatistics; Drexel University School of Public Health; Philadelphia PA USA
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Isabelle Le Ray
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Ji Yu Sun
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Agneta Wikman
- Department of Laboratory Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Stefan Johansson
- Clinical Epidemiology Unit; Department of Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Science and Education; Sachs' Children and Youth Hospital; Karolinska Institutet; Stockholm Sweden
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47
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Bhatt V, Shune L, Lauer E, Lubin M, Devlin SM, Scaradavou A, Parameswaran R, Perales MA, Ponce DM, Mantha S, Kernan NA, Barker JN. Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab. Bone Marrow Transplant 2016; 51:1579-83. [PMID: 27643868 DOI: 10.1038/bmt.2016.228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022]
Abstract
Autoimmune hemolysis (AH) and immune thrombocytopenic purpura (ITP) are recognized complications after cord blood transplantation (CBT). We evaluated the incidence and characteristics of AH/ITP after double-unit CBT in a day 100 landmark analysis of 152 patients (median age 36 years, range 0.9-70 years) transplanted for hematologic malignancies with myeloablative or nonmyeloablative conditioning and calcineurin inhibitor (CNI)/mycophenolate mofetil. With a median 5.2-year (range 1.6-9.7 years) survivor follow-up, 10 patients developed autoimmune cytopenias (8 AH, 1 ITP, 1 both) at a median of 10.4 months (range 5.8-24.5) post CBT for a 7% cumulative incidence 3 years after the day 100 landmark. Six patients presented with severe disease (hemoglobin ⩽6 g/dL and/or platelets <20 × 109/L). All AH patients were direct antiglobulin test positive. All 10 cases developed during immunosuppression taper with 8 having prior acute GVHD. All 10 patients received rituximab 2-18 days after diagnosis, and corticosteroids combined with rituximab within <7 days was the most effective. No patient died of AH/ITP. AH/ITP occurs infrequently after CBT but may be life-threatening requiring emergency therapy. Rituximab combined with corticosteroids at diagnosis is warranted in patients with severe disease.
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48
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Hansen DL, Overgaard UM, Pedersen L, Frederiksen H. Positive predictive value of diagnosis coding for hemolytic anemias in the Danish National Patient Register. Clin Epidemiol 2016; 8:241-52. [PMID: 27445504 PMCID: PMC4928658 DOI: 10.2147/clep.s93643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose The nationwide public health registers in Denmark provide a unique opportunity for evaluation of disease-associated morbidity if the positive predictive values (PPVs) of the primary diagnosis are known. The aim of this study was to evaluate the predictive values of hemolytic anemias registered in the Danish National Patient Register. Patients and methods All patients with a first-ever diagnosis of hemolytic anemia from either specialist outpatient clinic contact or inpatient admission at Odense University Hospital from January 1994 through December 2011 were considered for inclusion. Patients with mechanical reason for hemolysis such as an artificial heart valve, and patients with vitamin-B12 or folic acid deficiency were excluded. Results We identified 412 eligible patients: 249 with a congenital hemolytic anemia diagnosis and 163 with acquired hemolytic anemia diagnosis. In all, hemolysis was confirmed in 359 patients, yielding an overall PPV of 87.1% (95% confidence interval [CI]: 83.5%–90.2%). A diagnosis could be established in 392 patients of whom 355 patients had a hemolytic diagnosis. Diagnosis was confirmed in 197 of the 249 patients with congenital hemolytic anemia, yielding a PPV of 79.1% (95% CI: 73.5%–84.0%). Diagnosis of acquired hemolytic anemia could be confirmed in 136 of the 163 patients, resulting in a PPV of 83.4% (95% CI: 76.8%–88.8%). For hemoglobinopathy PPV was 84.1% (95% CI: 77.4%–89.4%), for hereditary spherocytosis PPV was 80.6% (95% CI: 69.5%–88.9%), and for autoimmune hemolytic anemia PPV was 78.4% (95% CI: 70.4%–85.0%). Conclusion The PPV of hemolytic anemias was moderately high. The PPVs were comparable in the three main categories of overall hemolysis, and congenital and acquired hemolytic anemia.
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Affiliation(s)
| | | | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, Odense; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Bennardello F, Coluzzi S, Curciarello G, Todros T, Villa S; Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) and Italian Society of Gynaecology and Obstetrics (SIGO) working group. Recommendations for the prevention and treatment of haemolytic disease of the foetus and newborn. Blood Transfus 2015; 13:109-34. [PMID: 25633877 DOI: 10.2450/2014.0119-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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50
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Özgönenel B, Kukreja G, O'Malley B, Bluth MH. Neonatal BO Incompatibility Is Associated With a Positive Cord Blood Direct Antiglobulin Test in Infants of Black Ethnicity. J Pediatr Hematol Oncol 2015; 37:e453-7. [PMID: 26422285 DOI: 10.1097/MPH.0000000000000426] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABO hemolytic disease of the newborn occurs almost exclusively in infants of blood group A and B who are born to group O mothers. Positive Direct Antiglobulin Test (DAT) can identify those infants who are at risk of developing the ABO hemolytic disease. Earlier studies have suggested that BO incompatibility is associated with a positive DAT in black infants. In this study we sought to determine whether ABO incompatibility type could be associated with a higher rate of DAT positivity or clinical hemolytic disease. We reviewed the electronic medical records of all ABO-incompatible births over a 2-year period. There were 1537 ABO-incompatible births during the study period. DAT was more commonly positive among BO incompatible (21.5% in BO vs. 14.8% in AO, P=0.001) and black (18.8% in blacks vs. 10.8% in nonblacks, P=0.003) infants. DAT positivity was significantly associated with both severe hyperbilirubinemia (P=0.028) and hemolytic anemia (P<0.001). BO incompatibility was significantly associated with hemolytic anemia, but not severe hyperbilirubinemia, in the infants tested.
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