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Tan L, Zhao Y. Analysis of multiple organ damage and clinical immunological characteristics in systemic lupus erythematosus patients with hematologic involvement. Int J Med Sci 2021; 18:2624-2629. [PMID: 34104094 PMCID: PMC8176184 DOI: 10.7150/ijms.48997] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate clinical immunological characteristics and imaging findings of multiple organ damage of systemic lupus erythematosus (SLE) patients with hematologic involvement. Methods: SLE patients diagnosed in the Second Affiliated Hospital of Nanchang University from June 2015 to March 2019 were selected, including 93 SLE patients with hematologic involvement and 68 SLE patients without hematologic involvement. Immunological indicators such as autoantibodies, immunoglobulin G (IgG), complement 4 (C4) and imaging data of several organs were measured respectively. The results were statistically analyzed. Results: SLE patients with hematologic involvement were more likely to have autoimmune hemolytic anemia (AIHA) (20.43%, P<0.05). The erythrocyte sedimentation rate (ESR) of SLE patients with hematologic involvement was 75.82 (±35.33) mm/h, IgG was 28.84 (±6.00) g/L and C4 was 0.073 (±0.031) g/L (P< 0.05). The area under the curve (AUC) of IgG was the highest among the above indicators (P<0.01). The positive anti-RO-52 antibody (OR=15.926, P<0.05) was an independent risk factor for pulmonary inflammatory lesions in SLE patients with hematologic involvement. Conclusion: Compared with the control group, abnormal immunological indicators and multiple organs damage are more obvious. Positive anti-RO-52 antibody may play an important role in the pathogenesis of pulmonary inflammation in SLE patients.
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MESH Headings
- Adult
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/epidemiology
- Anemia, Hemolytic, Autoimmune/immunology
- Autoantibodies/blood
- Autoantibodies/immunology
- Blood Sedimentation
- Female
- Humans
- Immunoglobulin G/immunology
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/immunology
- Male
- Middle Aged
- Multiple Organ Failure/blood
- Multiple Organ Failure/diagnosis
- Multiple Organ Failure/epidemiology
- Multiple Organ Failure/immunology
- Young Adult
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Affiliation(s)
- Liming Tan
- Department of Clinical Laboratory, Second Affiliated Hospital of Nanchang University, Jiangxi Key Laboratory of Laboratory Medicine, Nanchang 330006, China
| | - Yonglei Zhao
- Second Clinical Medical College, Nanchang University, Nanchang 330006, China
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Röth A, Barcellini W, D'Sa S, Miyakawa Y, Broome CM, Michel M, Kuter DJ, Jilma B, Tvedt THA, Fruebis J, Jiang X, Lin S, Reuter C, Morales-Arias J, Hobbs W, Berentsen S. Sutimlimab in Cold Agglutinin Disease. N Engl J Med 2021; 384:1323-1334. [PMID: 33826820 DOI: 10.1056/nejmoa2027760] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cold agglutinin disease is a rare autoimmune hemolytic anemia characterized by hemolysis that is caused by activation of the classic complement pathway. Sutimlimab, a humanized monoclonal antibody, selectively targets the C1s protein, a C1 complex serine protease responsible for activating this pathway. METHODS We conducted a 26-week multicenter, open-label, single-group study to assess the efficacy and safety of intravenous sutimlimab in patients with cold agglutinin disease and a recent history of transfusion. The composite primary end point was a normalization of the hemoglobin level to 12 g or more per deciliter or an increase in the hemoglobin level of 2 g or more per deciliter from baseline, without red-cell transfusion or medications prohibited by the protocol. RESULTS A total of 24 patients were enrolled and received at least one dose of sutimlimab; 13 patients (54%) met the criteria for the composite primary end point. The least-squares mean increase in hemoglobin level was 2.6 g per deciliter at the time of treatment assessment (weeks 23, 25, and 26). A mean hemoglobin level of more than 11 g per deciliter was maintained in patients from week 3 through the end of the study period. The mean bilirubin levels normalized by week 3. A total of 17 patients (71%) did not receive a transfusion from week 5 through week 26. Clinically meaningful reductions in fatigue were observed by week 1 and were maintained throughout the study. Activity in the classic complement pathway was rapidly inhibited, as assessed by a functional assay. Increased hemoglobin levels, reduced bilirubin levels, and reduced fatigue coincided with inhibition of the classic complement pathway. At least one adverse event occurred during the treatment period in 22 patients (92%). Seven patients (29%) had at least one serious adverse event, none of which were determined by the investigators to be related to sutimlimab. No meningococcal infections occurred. CONCLUSIONS In patients with cold agglutinin disease who received sutimlimab, selective upstream inhibition of activity in the classic complement pathway rapidly halted hemolysis, increased hemoglobin levels, and reduced fatigue. (Funded by Sanofi; CARDINAL ClinicalTrials.gov number, NCT03347396.).
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MESH Headings
- Aged
- Aged, 80 and over
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/therapy
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Blood Transfusion
- Complement C1s/antagonists & inhibitors
- Fatigue/drug therapy
- Fatigue/etiology
- Female
- Hemoglobins/analysis
- Hemolysis/drug effects
- Humans
- Male
- Middle Aged
- Quality of Life
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Affiliation(s)
- Alexander Röth
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Wilma Barcellini
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Shirley D'Sa
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Yoshitaka Miyakawa
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Catherine M Broome
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Marc Michel
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - David J Kuter
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Bernd Jilma
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Tor H A Tvedt
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Joachim Fruebis
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Xiaoyu Jiang
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Stella Lin
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Caroline Reuter
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Jaime Morales-Arias
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - William Hobbs
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
| | - Sigbjørn Berentsen
- From the Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany (A.R.); Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy (W.B.); the Centre for Waldenström's Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London (S.D.); the Thrombosis and Hemostasis Center, Saitama Medical University Hospital, Saitama, Japan (Y.M.); the Division of Hematology, MedStar Georgetown University Hospital, Washington, DC (C.M.B.); the Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Créteil, France (M.M.); the Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston (D.J.K.), Bioverativ, Cambridge (J.F.), and Sanofi, Waltham (X.J., S.L., C.R., J.M.-A., W.H.) - all in Massachusetts; the Department of Clinical Pharmacology, Medical University of Vienna, Vienna (B.J.); and the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen (T.H.A.T.), and the Department of Research and Innovation, Haugesund Hospital, Haugesund (S.B.) - both in Norway
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Pelle MC, Tassone B, Ricchio M, Mazzitelli M, Davoli C, Procopio G, Cancelliere A, La Gamba V, Lio E, Matera G, Quirino A, Barreca GS, Trecarichi EM, Torti C. Late-onset myocardial infarction and autoimmune haemolytic anaemia in a COVID-19 patient without respiratory symptoms, concomitant with a paradoxical increase in inflammatory markers: a case report. J Med Case Rep 2020; 14:246. [PMID: 33339534 PMCID: PMC7746982 DOI: 10.1186/s13256-020-02595-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events. CASE PRESENTATION We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury. CONCLUSIONS Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).
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Affiliation(s)
- Maria Chiara Pelle
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy.
| | - Bruno Tassone
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Marco Ricchio
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Chiara Davoli
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giada Procopio
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Anna Cancelliere
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Valentina La Gamba
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Elena Lio
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Giovanni Matera
- Department of Health Sciences, Unit of Clinical Microbiology, University "Magna Graecia", Catanzaro, Italy
| | - Angela Quirino
- Department of Health Sciences, Unit of Clinical Microbiology, University "Magna Graecia", Catanzaro, Italy
| | | | - Enrico Maria Trecarichi
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
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4
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Borchert C, Herman A, Roth M, Brooks AC, Friedenberg SG. RNA sequencing of whole blood in dogs with primary immune-mediated hemolytic anemia (IMHA) reveals novel insights into disease pathogenesis. PLoS One 2020; 15:e0240975. [PMID: 33091028 PMCID: PMC7580939 DOI: 10.1371/journal.pone.0240975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
Immune-mediated hemolytic anemia (IMHA) is a life-threatening autoimmune disorder characterized by a self-mediated attack on circulating red blood cells. The disease occurs naturally in both dogs and humans, but is significantly more prevalent in dogs. Because of its shared features across species, dogs offer a naturally occurring model for studying IMHA in people. In this study, we used RNA sequencing of whole blood from treatment-naïve dogs to study transcriptome-wide changes in gene expression in newly diagnosed animals compared to healthy controls. We found many overexpressed genes in pathways related to neutrophil function, coagulation, and hematopoiesis. In particular, the most highly overexpressed gene in cases was a phospholipase scramblase, which mediates the externalization of phosphatidylserine from the inner to the outer leaflet of cell membranes. This family of genes has been shown to be critically important for programmed cell death of erythrocytes as well as the initiation of the clotting cascade. Unexpectedly, we found marked underexpression of many genes related to lymphocyte function. We also identified groups of genes that are highly associated with the inflammatory response and red blood cell regeneration in affected dogs. We did not find any genes that distinguished dogs that lived vs. those that died at 30 days following diagnosis, nor did we find any relevant genomic signatures of microbial organisms in the blood of affected animals. Future studies are warranted to validate these findings and assess their implication in developing novel therapeutic approaches for dogs and humans with IMHA.
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Affiliation(s)
- Corie Borchert
- Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine, St. Paul, Minnesota, United States of America
| | - Adam Herman
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Megan Roth
- Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine, St. Paul, Minnesota, United States of America
| | - Aimee C. Brooks
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, United States of America
| | - Steven G. Friedenberg
- Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine, St. Paul, Minnesota, United States of America
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5
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Wahlster L, Weichert-Leahey N, Trissal M, Grace RF, Sankaran VG. COVID-19 presenting with autoimmune hemolytic anemia in the setting of underlying immune dysregulation. Pediatr Blood Cancer 2020; 67:e28382. [PMID: 32495391 PMCID: PMC7674227 DOI: 10.1002/pbc.28382] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/09/2022]
MESH Headings
- Adolescent
- Adrenal Cortex Hormones/administration & dosage
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/pathology
- Anemia, Hemolytic, Autoimmune/therapy
- Benzoates/administration & dosage
- Betacoronavirus/metabolism
- COVID-19
- Coronavirus Infections/blood
- Coronavirus Infections/diagnosis
- Coronavirus Infections/pathology
- Coronavirus Infections/therapy
- Erythrocyte Transfusion
- Humans
- Hydrazines/administration & dosage
- Male
- Mycophenolic Acid/administration & dosage
- Oxygen/administration & dosage
- Pandemics
- Pneumonia, Viral/blood
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/pathology
- Pneumonia, Viral/therapy
- Pyrazoles/administration & dosage
- SARS-CoV-2
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Affiliation(s)
- Lara Wahlster
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Nina Weichert-Leahey
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Maria Trissal
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Rachael F Grace
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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6
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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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7
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Piatek CI, Bocian H, Algaze S, Weitz IC, O'Connell C, Liebman HA. A Retrospective Study of the Combination of Rituximab, Cyclophosphamide and Dexamethasone for the Treatment of Relapsed/Refractory Warm Antibody Autoimmune Hemolytic Anemia. Acta Haematol 2019; 143:244-249. [PMID: 31665725 DOI: 10.1159/000501538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
Abstract
The combination of rituximab, cyclophosphamide, and dexamethasone (RCD) is highly effective in the treatment of warm autoimmune hemolytic anemia (WAIHA) associated with chronic lymphocytic leukemia (CLL). We treated a cohort of patients with relapsed/refractory WAIHA, without CLL, with RCD. The primary objective was to evaluate the overall response (OR) of RCD therapy. Complete response (CR) was defined as a hemoglobin (Hgb) ≥12 g/dL. Partial response (PR) was defined as Hgb 10-11.9 g/dL or ≥2 g/dL increase in Hgb. Sustained response was defined as Hgb ≥10 g/dL with no treatment changes. A total of 16 patients with relapsed/refractory WAIHA received RCD (7 primary WAIHA, 9 secondary WAIHA) for a median of 4 cycles (range: 2-6). The median pretreatment Hgb was 10.0 g/dL (range: 4.3-12.2). The median best Hgb achieved was 12.5 g/dL (range: 10.6-15.1) with a median of 2 cycles until best Hgb response. The OR was 94% (11 CR, 4 PR). Two immunocompromised patients were admitted for infections during RCD treatment. There were no deaths during the treatment or follow-up period. Following a response to RCD, 4 patients received noncorticosteroid immune modulation therapy and 4 patients continued on corticosteroid therapy. Seven patients received no additional treatment.
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Affiliation(s)
- Caroline I Piatek
- Jane Anne Nohl Division of Hematology, Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA,
- Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA,
| | - Hillel Bocian
- Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
| | - Sandra Algaze
- Jane Anne Nohl Division of Hematology, Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
- Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
| | - Ilene C Weitz
- Jane Anne Nohl Division of Hematology, Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
- Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
| | - Casey O'Connell
- Jane Anne Nohl Division of Hematology, Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
- Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
| | - Howard A Liebman
- Jane Anne Nohl Division of Hematology, Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
- Department of Medicine, University of Southern California - Keck School of Medicine, Los Angeles, California, USA
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9
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Abstract
BACKGROUND Cold agglutinin disease is a very rare condition associated with agglutination of erythrocytes in cold environment usually due to IgM type antibodies. Other than hemolytic anemias, it may interfere with routine hemogram tests due to miscalculation of red blood cell count (RBC) and other hemogram parameters calculated with involvement of RBC. Awareness of the condition is important to overcome laboratory errors. METHODS We studied a peripheral blood smear and repeated the hemogram test at 37°C to establish the diagnosis of cold agglutinin disease. RESULTS Initial hemogram test results of the fifty-eight year-old man was as follows: RBC: 1.34 M/µL, hemoglobin (Hb): 12.4 g/dL, hematocrit (Htc): 11.8%, mean corpuscular hemoglobin (MCH): 92.4 pg, and mean corpuscular hemoglobin concentration (MCHC): 105 gr/dL. Despite the standard indirect Coombs test being negative, repeated tests at room temperature was 4+. We suspected cold agglutinin disease and repeated the hemogram test using the Bain-Marie method at 37°C and the test results showed RBC: 3.4 M/µL, hemoglobin: 12.6 g/dL, hematocrit: 30.2%, MCH: 31.7 pg, and MCHC: 41.8 g/dL. CONCLUSIONS Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results.
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10
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Affiliation(s)
- Robert A Brodsky
- From the Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore
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11
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Gertz MA. How I treat cold agglutinin hemolytic anemia. Clin Adv Hematol Oncol 2019; 17:338-343. [PMID: 31437137] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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12
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Karp Leaf R, Ferreri C, Rangachari D, Mier J, Witteles W, Ansstas G, Anagnostou T, Zubiri L, Piotrowska Z, Oo TH, Iberri D, Yarchoan M, Salama A, Johnson DB, Leavitt AD, Rahma O, Reynolds KL, Leaf DE. Clinical and laboratory features of autoimmune hemolytic anemia associated with immune checkpoint inhibitors. Am J Hematol 2019; 94:563-574. [PMID: 30790338 PMCID: PMC9552038 DOI: 10.1002/ajh.25448] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 01/04/2019] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
Abstract
Immune checkpoint inhibitors (ICPis) are a novel class of immunotherapeutic agents that have revolutionized the treatment of cancer; however, these drugs can also cause a unique spectrum of autoimmune toxicity. Autoimmune hemolytic anemia (AIHA) is a rare, but often severe, complication of ICPis. We identified 14 patients from nine institutions across the United States who developed ICPi-AIHA. The median interval from ICPi initiation to development of AIHA was 55 days (interquartile range [IQR], 22-110 days). Results from the direct antiglobulin test (DAT) were available for 13 of 14 patients: 8 patients (62%) had a positive DAT and 5 (38%) had a negative DAT. The median pretreatment and nadir hemoglobin concentrations were 11.8 g/dL (IQR, 10.2-12.9 g/dL) and 6.3 g/dL (IQR, 6.1-8.0 g/dL), respectively. Four patients (29%) had a preexisting lymphoproliferative disorder, and two (14%) had a positive DAT prior to initiation of ICPi therapy. All patients were treated with glucocorticoids, with three requiring additional immunosuppressive therapy. Complete and partial recoveries of hemoglobin were achieved in 12 (86%) and 2 (14%) patients, respectively. Seven patients (50%) were rechallenged with ICPis, and one (14%) developed recurrent AIHA. Clinical and laboratory features of ICPi-AIHA were similar in DAT positive and negative patients. ICPi-AIHA shares many clinical features with primary AIHA; however, a unique aspect of ICPi-AIHA is a high incidence of DAT negativity. Glucocorticoids are an effective first-line treatment in the majority of patients with ICPi-AIHA, and most patients who are rechallenged with an ICPi do not appear to develop recurrence of AIHA.
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Affiliation(s)
- Rebecca Karp Leaf
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | | | - Deepa Rangachari
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - James Mier
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Wesley Witteles
- Divison of Hematology and Oncology, VA Palo Alto Health Care System, Palo Alto, CA
| | - George Ansstas
- Division of Hematology and Oncology, Washington University St. Louis, St. Louis, MO
| | | | - Leyre Zubiri
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Zofia Piotrowska
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Thein H. Oo
- Section of Benign Hematology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - David Iberri
- Division of Hematology, Stanford University Medical Center, Stanford, CA
| | - Mark Yarchoan
- Division of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - April Salama
- Department of Internal Medicine, Duke University Hospital, Durham, NC
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew D. Leavitt
- Division of Hematology and Oncology, University of California San Francisco, San Francisco, CA
| | - Osama Rahma
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
| | - Kerry Lynn Reynolds
- Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - David E. Leaf
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
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13
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Feld J, Arnason J, O Apos Brien K, Nahas M. Hot and Cold: A Concurrent Warm and Cold Autoimmune Hemolytic Anemia in B-cell Prolymphocytic Leukemia. Acta Haematol 2019; 141:222-224. [PMID: 30947164 DOI: 10.1159/000495779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Jonathan Feld
- Division of Hematology/Medical Oncology, Tisch Cancer Institute, Mount Sinai Hospital, Icahn School of Medicine, New York, New York, USA,
| | - Jon Arnason
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry O Apos Brien
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Myrna Nahas
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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14
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Abstract
A 79-year-old man with Sjögren's syndrome and systemic lupus erythematosus developed acute impaired consciousness and hemolytic anemia. The patient's red blood cells agglutinated spontaneously at 25-37°C. The treatment of red blood cells with 2-mercaptoethanol resulted in the loss of spontaneous agglutination. A diagnosis of IgM-mediated warm autoimmune hemolytic anemia was made. The patient received steroid pulse and plasma exchange therapies. Rituximab was also administered. However, the patient died from multiple organ failure at six days from the symptom onset. The clinical progress of the patient and autopsy findings suggested that complement activation might have been associated with the pathology.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/immunology
- Antibodies, Anti-Idiotypic/blood
- Antibodies, Anti-Idiotypic/immunology
- Autopsy
- Fatal Outcome
- Humans
- Immunoglobulin M/blood
- Immunoglobulin M/immunology
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Male
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Affiliation(s)
- Takahiko Ito
- Department of Internal Medicine, Ako City Hospital, Japan
| | - Natsuka Tojo
- Department of Internal Medicine, Ako City Hospital, Japan
| | | | | | | | - Shigeo Hara
- Department of Pathology, Ako City Hospital, Japan
| | - Kouhei Takesue
- Department of Internal Medicine, Ako City Hospital, Japan
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15
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Abstract
Weil syndrome is a fulminant form of leptospirosis, usually caused by spirochetal organism Leptospira interrogans. It is characterized by icterus, petechial rashes over the body, signs of renal failure and hepatic failure. Anaemia is a usual manifes- tation of Leptospira infection, but autoimmune haemolytic anaemia is rare. We report a patient with autoimmune haemolytic anaemia following Leptospira infection, which was responsive to high-dose steroid therapy.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Anti-Bacterial Agents/therapeutic use
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/immunology
- Drug Therapy, Combination/methods
- Glucocorticoids/administration & dosage
- Hemoglobins/analysis
- Humans
- Immunoglobulin M/blood
- Immunoglobulin M/immunology
- Leptospira interrogans/immunology
- Leptospira interrogans/isolation & purification
- Male
- Middle Aged
- Treatment Outcome
- Weil Disease/complications
- Weil Disease/diagnosis
- Weil Disease/drug therapy
- Weil Disease/microbiology
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Affiliation(s)
- Rahul Sai Gangula
- Department of Medicine, Kasturba Medical College, Sharada Madhava Pai OPD Block, Manipal, Karnataka, India
| | - M Mukhyaprana Prabhu
- Department of Medicine, Kasturba Medical College, Sharada Madhava Pai OPD Block, Manipal, Karnataka, India
| | - Weena Stanley
- Department of Medicine, Kasturba Medical College, Sharada Madhava Pai OPD Block, Manipal, Karnataka, India
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16
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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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17
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Abstract
The diagnosis of autoimmune hemolytic anemia (AIHA) can be made with a stepwise approach that aims to identify laboratory and clinical evidence of hemolysis and then determine the immune nature of hemolysis with the direct anti-globulin test. Once alternative causes for these findings have been excluded, AIHA is established, and the clinician must search for secondary causes, as well as identify the type of AIHA. Rituximab is now the preferred second-line treatment for primary warm AIHA and first-line treatment for primary cold agglutinin disease (CAD), either as monotherapy or combined with bendamustine. Complement inhibitors have shown utility in stabilizing AIHA patients with acute severe hemolysis. Future prospects are discussed and include the C1s inhibitor BIVV009 (sutimlimab) that is now entering phase 3 studies for CAD.
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Affiliation(s)
- Anita Hill
- Department of Haematology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Quentin A Hill
- Department of Haematology, Leeds Teaching Hospitals, Leeds, United Kingdom
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18
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Audia S, Bach B, Samson M, Lakomy D, Bour JB, Burlet B, Guy J, Duvillard L, Branger M, Leguy-Seguin V, Berthier S, Michel M, Bonnotte B. Venous thromboembolic events during warm autoimmune hemolytic anemia. PLoS One 2018; 13:e0207218. [PMID: 30408135 PMCID: PMC6224177 DOI: 10.1371/journal.pone.0207218] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/26/2018] [Indexed: 12/30/2022] Open
Abstract
Thrombotic manifestations are a hallmark of many auto-immune diseases (AID), specially of warm autoimmune hemolytic anemia (wAIHA), as 15 to 33% of adults with wAIHA experience venous thromboembolic events (VTE). However, beyond the presence of positive antiphospholipid antibodies and splenectomy, risk factors for developing a VTE during wAIHA have not been clearly identified. The aim of this retrospective study was to characterize VTEs during wAIHA and to identify risk factors for VTE. Forty-eight patients with wAIHA were included, among whom 26 (54%) had secondary wAIHA. Eleven (23%) patients presented at least one VTE, that occurred during an active phase of the disease for 10/11 patients (90%). The frequency of VTE was not different between primary and secondary AIHA (23.7 vs. 19.2%; p = 0.5). The Padua prediction score based on traditional risk factors was not different between patients with and without VTE. On multivariate analysis, total bilirubin ≥ 40 μmol/L [odds ratio (OR) = 7.4; p = 0.02] and leucocyte count above 7x109/L (OR = 15.7; p = 0.02) were significantly associated with a higher risk of thrombosis. Antiphospholipid antibodies were screened in 9 out the 11 patients who presented a VTE and were negative. Thus, the frequency of VTE is high (23%) during wAIHA and VTE preferentially occur within the first weeks of diagnosis. As no clinically relevant predictive factors of VTE could be identified, the systematic use of a prophylactic anticoagulation should be recommended in case of active hemolysis and its maintenance after hospital discharge should be considered. The benefit of a systematic screening for VTE and its procedure remain to be determined.
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Affiliation(s)
- Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Constitutive Referral Center for Autoimmune Cytopenias, University Hospital, Dijon, France
- * E-mail:
| | - Benoit Bach
- Department of Internal Medicine and Clinical Immunology, Constitutive Referral Center for Autoimmune Cytopenias, University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Constitutive Referral Center for Autoimmune Cytopenias, University Hospital, Dijon, France
| | - Daniela Lakomy
- Immunology laboratory, University Hospital, Dijon, France
| | | | | | - Julien Guy
- Hematobiology, University Hospital, Dijon, France
| | | | | | - Vanessa Leguy-Seguin
- Department of Internal Medicine and Clinical Immunology, Constitutive Referral Center for Autoimmune Cytopenias, University Hospital, Dijon, France
| | - Sabine Berthier
- Department of Internal Medicine and Clinical Immunology, Constitutive Referral Center for Autoimmune Cytopenias, University Hospital, Dijon, France
| | - Marc Michel
- Department of Internal Medicine, Referral Center for Autoimmune Cytopenias, Henri Mondor University Hospital, Creteil, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Constitutive Referral Center for Autoimmune Cytopenias, University Hospital, Dijon, France
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19
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Suzuki T, Miyakoshi S, Nanba A, Uchiyama T, Kawamoto K, Aoki S. A case of chronic lymphocytic leukemia complicated by autoimmune hemolytic anemia due to ibrutinib treatment. J Clin Exp Hematop 2018; 58:136-140. [PMID: 30012921 PMCID: PMC6408179 DOI: 10.3960/jslrt.18012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Ibrutinib (IBR) covalently binds to the active site of Bruton's tyrosine kinase (BTK) and is used for the treatment of relapsed/refractory chronic lymphocytic leukemia (CLL). Approximately 5-10% of CLL is complicated by autoimmune cytopenia (AIC), such as autoimmune hemolytic anemia (AIHA). Several cases of AIC have reportedly demonstrated improvement during IBR treatment. However, in our case, the patient developed AIHA during oral IBR treatment. As AIHA is exacerbated by the increased number of CLL cells in the peripheral blood, it may have developed because of disease progression rather than IBR use. This phenomenon may also be attributed to the production of autoantibodies due to increased number of CD5+ B cells. In this case, withdrawal of IBR and administration of rituximab improved hemolysis. If AIHA develops during treatment, its etiology must be examined to confirm the effects of treatment.
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MESH Headings
- Adenine/analogs & derivatives
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/chemically induced
- Anemia, Hemolytic, Autoimmune/drug therapy
- Autoantibodies/blood
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Male
- Piperidines
- Pyrazoles/administration & dosage
- Pyrazoles/adverse effects
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
- Rituximab/administration & dosage
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20
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Hamer HM, Beckers EA, Henskens YM. [Haemolysis: role of the direct antiglobulin test and eluate]. Ned Tijdschr Geneeskd 2018; 161:D1290. [PMID: 29350115] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Haemolytic anaemia is the result of an abnormal breakdown of red blood cells. The direct antiglobulin test (DAT), also known as the direct Coombs test, can be used to determine the cause of the haemolysis. The DAT distinguishes between immune and non-immune causes of haemolysis. However, the DAT should not be used in screening for haemolysis. When the DAT is performed without an indication for in vivo haemolysis, there is a high risk of false-positive results. To increase the specificity of the DAT, the eluate can be tested to determine the specificity of the autoantibodies. In this article we present two cases of haemolytic anaemia in which the DAT gives further indication of the cause of haemolysis.
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21
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Swann JW, Woods K, Wu Y, Glanemann B, Garden OA. Characterisation of the Immunophenotype of Dogs with Primary Immune-Mediated Haemolytic Anaemia. PLoS One 2016; 11:e0168296. [PMID: 27942026 PMCID: PMC5152924 DOI: 10.1371/journal.pone.0168296] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/28/2016] [Indexed: 01/03/2023] Open
Abstract
Background Immune-mediated haemolytic anaemia (IMHA) is reported to be the most common autoimmune disease of dogs, resulting in significant morbidity and mortality in affected animals. Haemolysis is caused by the action of autoantibodies, but the immunological changes that result in their production have not been elucidated. Aims To investigate the frequency of regulatory T cells (Tregs) and other lymphocyte subsets and to measure serum concentrations of cytokines and peripheral blood mononuclear cell expression of cytokine genes in dogs with IMHA, healthy dogs and dogs with inflammatory diseases. Animals 19 dogs with primary IMHA, 22 dogs with inflammatory diseases and 32 healthy control dogs. Methods Residual EDTA-anti-coagulated blood samples were stained with fluorophore-conjugated monoclonal antibodies and analysed by flow cytometry to identify Tregs and other lymphocyte subsets. Total RNA was also extracted from peripheral blood mononuclear cells to investigate cytokine gene expression, and concentrations of serum cytokines (interleukins 2, 6 10, CXCL-8 and tumour necrosis factor α) were measured using enhanced chemiluminescent assays. Principal component analysis was used to investigate latent variables that might explain variability in the entire dataset. Results There was no difference in the frequency or absolute numbers of Tregs among groups, nor in the proportions of other lymphocyte subsets. The concentrations of pro-inflammatory cytokines were greater in dogs with IMHA compared to healthy controls, but the concentration of IL-10 and the expression of cytokine genes did not differ between groups. Principal component analysis identified four components that explained the majority of the variability in the dataset, which seemed to correspond to different aspects of the immune response. Conclusions The immunophenotype of dogs with IMHA differed from that of dogs with inflammatory diseases and from healthy control dogs; some of these changes could suggest abnormalities in peripheral tolerance that permit development of autoimmune disease. The frequency of Tregs did not differ between groups, suggesting that deficiency in the number of these cells is not responsible for development of IMHA.
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Affiliation(s)
- James W. Swann
- Department of Clinical Science and Services, Royal Veterinary College, Hawskhead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
- Immune Regulation Laboratory, Royal Veterinary College, London, United Kingdom
| | - Kelly Woods
- Immune Regulation Laboratory, Royal Veterinary College, London, United Kingdom
| | - Ying Wu
- Immune Regulation Laboratory, Royal Veterinary College, London, United Kingdom
| | - Barbara Glanemann
- Department of Clinical Science and Services, Royal Veterinary College, Hawskhead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
| | - Oliver A. Garden
- Department of Clinical Science and Services, Royal Veterinary College, Hawskhead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
- Immune Regulation Laboratory, Royal Veterinary College, London, United Kingdom
- * E-mail:
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22
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Abstract
Primary chronic cold agglutinin disease (CAD) is a well-defined clinicopathologic entity in which a specific, clonal lymphoproliferative B-cell bone marrow disorder results in autoimmune hemolytic anemia. The immune hemolysis is entirely complement-dependent, predominantly mediated by activation of the classical pathway and phagocytosis of erythrocytes opsonized with complement protein C3b. Typical clinical features in CAD have diagnostic and therapeutic implications. Pharmacologic treatment should be offered to patients with symptom-producing anemia or disabling circulatory symptoms. CAD should not be treated with corticosteroids. Based on an individualized approach, rituximab monotherapy or rituximab-fludarabine in combination is recommended as first-line therapy. Rituximab-bendamustine is still an investigational therapy. Although complement-modulating agents are still to be considered experimental in CAD, therapy with the anti-C1s monoclonal antibody TNT009 seems promising.
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Affiliation(s)
- Sigbjørn Berentsen
- Department of Research and Innovation, Haugesund Hospital, Helse Fonna, Haugesund, Norway
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23
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Chatterjee S, Bhardwaj N, Saxena RK. Identification of Stages of Erythroid Differentiation in Bone Marrow and Erythrocyte Subpopulations in Blood Circulation that Are Preferentially Lost in Autoimmune Hemolytic Anemia in Mouse. PLoS One 2016; 11:e0166878. [PMID: 27870894 PMCID: PMC5117735 DOI: 10.1371/journal.pone.0166878] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/04/2016] [Indexed: 01/13/2023] Open
Abstract
Repeated weekly injections of rat erythrocytes produced autoimmune hemolytic anemia (AIHA) in C57BL/6 mice after 5–6 weeks. Using the double in vivo biotinylation (DIB) technique, recently developed in our laboratory, turnover of erythrocyte cohorts of different age groups during AIHA was monitored. Results indicate a significant decline in the proportion of reticulocytes, young and intermediate age groups of erythrocytes, but a significant increase in the proportion of old erythrocytes in blood circulation. Binding of the autoantibody was relatively higher to the young erythrocytes and higher levels of intracellular reactive oxygen species (ROS) were also seen in these cells. Erythropoietic activity in the bone marrows and the spleen of AIHA induced mice was examined by monitoring the relative proportion of erythroid cells at various stages of differentiation in these organs. Cells at different stages of differentiation were enumerated flow cytometrically by double staining with anti-Ter119 and anti-transferrin receptor (CD71) monoclonal antibodies. Erythroid cells in bone marrow declined significantly in AIHA induced mice, erythroblast C being most affected (50% decline). Erythroblast C also recorded high intracellular ROS level along with increased levels of membrane-bound autoantibody. No such decline was observed in spleen. A model of AIHA has been proposed indicating that binding of autoantibodies may not be a sufficient condition for destruction of erythroid cells in bone marrow and in blood circulation. Last stage of erythropoietic differentiation in bone marrow and early stages of erythrocytes in blood circulation are specifically susceptible to removal in AIHA.
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Affiliation(s)
- Sreoshi Chatterjee
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
- Faculty of Life Sciences and Biotechnology, South Asian University, New Delhi, India
| | - Nitin Bhardwaj
- Faculty of Life Sciences and Biotechnology, South Asian University, New Delhi, India
| | - Rajiv K. Saxena
- Faculty of Life Sciences and Biotechnology, South Asian University, New Delhi, India
- * E-mail:
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24
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Tholpady A, Bracey AW, Baker KR, Reul RM, Chen AJ. Use of an Intravascular Warming Catheter during Off-Pump Coronary Artery Bypass Surgery in a Patient with Severe Cold Hemagglutinin Disease. Tex Heart Inst J 2016; 43:363-6. [PMID: 27547154 DOI: 10.14503/thij-15-5672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/23/2022]
Abstract
Cold hemagglutinin disease with broad thermal amplitude and high titers presents challenges in treating cardiac-surgery patients. Careful planning is needed to prevent the activation of cold agglutinins and the agglutination of red blood cells as the patient's temperature drops during surgery. We describe our approach to mitigating cold agglutinin formation in a 77-year-old man with severe cold hemagglutinin disease who underwent off-pump coronary artery bypass surgery without the use of preoperative plasmapheresis. This experience shows that the use of an intravascular warming catheter can maintain normothermia and prevent the activation and subsequent formation of cold agglutinins. To our knowledge, this is the first reported use of this technique in a patient with cold hemagglutinin disease. The chief feature in this approach is the use of optimal thermal maintenance-rather than the more usual decrease in cold-agglutinin content by means of therapeutic plasma exchange.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/immunology
- Coronary Artery Bypass, Off-Pump
- Coronary Artery Disease/complications
- Coronary Artery Disease/diagnostic imaging
- Coronary Artery Disease/surgery
- Equipment Design
- Hemagglutinins/blood
- Humans
- Hyperthermia, Induced/instrumentation
- Hyperthermia, Induced/methods
- Male
- Severity of Illness Index
- Treatment Outcome
- Vascular Access Devices
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25
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Abstract
A 51 year old woman with systemic lupus erythematosus (SLE) serially developed thrombocytopenia, arthritis, lupus nephritis, pleuritis, mesenteric vasculitis and refractory hemolytic anemia during the past 19 years prior to presentation. The woman had been managed with high doses of prednisolone, splenectomy, methylprednisolone pulse therapy and cytotoxic drugs, including oral cyclophosphamide, azathioprine, mexotrexate and monthly parenteral cyclophosphamide for hemolytic anemia. After two months of therapeutic trial with Cyclosporin A (CsA) (3 mg/kg), the follow-up hemoglobin (Hb) level was increased to 12.0 gm% and the dose of prednislone was reduced to 5 mg every other day without occurring rebound during the subsequent three months. There were no obvious side effects from the medication.
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Affiliation(s)
- S W Wang
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
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26
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Xu Y, Yang W, Liao L, Deng Z, Qiu Y, Chen W, Lin F. Mean reticulocyte volume: a specific parameter to screen for hereditary spherocytosis. Eur J Haematol 2016; 96:170-4. [PMID: 25868528 DOI: 10.1111/ejh.12563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Accepted: 04/09/2015] [Indexed: 11/30/2022]
Abstract
This study assessed the value of mean reticulocyte volume (MRV) for differential diagnosis of hereditary spherocytosis (HS) so as to develop conventional and new specific screen indexes. Subjects in this study were divided into three groups: 53 cases in HS group, 217 cases in hemolytic anemia control group (109 cases of thalassemia (THAL), 56 cases of glucose-6-phosphate dehydrogenase G6PD deficiency anemia, and 52 cases of autoimmune hemolytic anemia (AIHA)), and 100 cases in healthy control group. We analyzed erythrocyte and reticulocyte parameters including MRV, mean sphered corpuscular volume, mean corpuscular hemoglobin concentration, and immature reticulocyte fraction. Results demonstrated that MRV was significantly lower in the HS group but significantly higher in the AIHA and G6PD deficiency anemia groups than that in the healthy control group (P = 0.000). MRV was not significantly different between the AIHA and G6PD deficiency anemia groups (P = 0.977) and between the healthy control and THAL groups (P = 0.168). The area under the ROC curve of MRV for diagnosis of HS was 0.942, with a standard error of 0.019, 95% confidence interval of 0.905-0.979, and optimal critical diagnosis point of 95.77 fL. When the MRV was ≤95.77 fL, the sensitivity and specificity for diagnosis of HS were 86.80% and 91.20%, respectively. Therefore, MRV is a general and specific new index for screening HS and important for differential diagnosis of different types of hemolytic anemia.
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MESH Headings
- Adolescent
- Adult
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/pathology
- Area Under Curve
- Biomarkers/blood
- Case-Control Studies
- Child
- Child, Preschool
- Diagnosis, Differential
- Erythrocyte Indices
- Female
- Glucosephosphate Dehydrogenase Deficiency/blood
- Glucosephosphate Dehydrogenase Deficiency/diagnosis
- Glucosephosphate Dehydrogenase Deficiency/pathology
- Humans
- Male
- Middle Aged
- Reticulocyte Count
- Reticulocytes/metabolism
- Reticulocytes/pathology
- Spherocytosis, Hereditary/blood
- Spherocytosis, Hereditary/diagnosis
- Spherocytosis, Hereditary/pathology
- Thalassemia/blood
- Thalassemia/diagnosis
- Thalassemia/pathology
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Affiliation(s)
- Yuchan Xu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wang Yang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lin Liao
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zengfu Deng
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yuling Qiu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wenqiang Chen
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Faquan Lin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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27
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Froom P, Barak M. Auto-validation of complete blood counts in an outpatient's regional laboratory. Clin Chem Lab Med 2015; 53:275-9. [PMID: 25153407 DOI: 10.1515/cclm-2014-0572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/14/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The rate of auto-validation is dependent on the ability of the laboratory information system (LIS) to integrate historical data, on the frequency and methods for identifying analyzer errors, and on the criteria for reflex testing, including the need for peripheral smear review. The rate of auto-validation in outpatient laboratories, however, is unclear. METHODS We examined 45,925 consecutive complete blood count (CBC) test results (1 January, 2014-31 January, 2014) from patients aged 50±24 years. The LIS auto-validates all samples according to set criteria. Technicians validated test results when previous CBC test results were required to determine: 1) the need for peripheral slide review and/or sample rerun or 2) the need for reflex testing to detect autoimmune hemolytic anemia or β-thalassemia minor. RESULTS The auto-validation rates were 97.6% after rejecting results requiring validation to determine the need for a peripheral smear review and/or sample rerun. This decreased to 92.9% after including reflex testing to determine the reasons for normocytic and microcytic anemia. We estimated that auto-validation decreased the workload by 7.7-11.6 h per 3000 test results. CONCLUSIONS We conclude that very high auto-validation rates are possible in outpatient general laboratories, leading to conformity in the validation process and a considerable estimated savings in technician time. Further studies are needed in other settings.
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28
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Levina AA, Mesheryakova LM, Tsibulskaya MM, Sokolova TV. [THE DIFFERENTIAL DIAGNOSTIC OF ANEMIA]. Klin Lab Diagn 2015; 60:26-30. [PMID: 27032249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The article presents analysis of the publications' data of the recent years concerning regulation of iron metabolism and possibilities of application of indicators of iron metabolism in differential diagnostic of anemia. The original results of protein detection are described concerning bivalent transporter of metals and ferroportine under iron-deficiency anemia, anemia of chronic inflammatory diseases and autoimmune hemolytic anemia. The significance of these proteins in more profound comprehension of pathogenesis is demonstrated
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MESH Headings
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/genetics
- Anemia, Hemolytic, Autoimmune/pathology
- Anemia, Iron-Deficiency/blood
- Anemia, Iron-Deficiency/diagnosis
- Anemia, Iron-Deficiency/genetics
- Anemia, Iron-Deficiency/pathology
- Cation Transport Proteins/blood
- Cation Transport Proteins/genetics
- Chronic Disease
- Diagnosis, Differential
- Ferritins/blood
- Ferritins/genetics
- Gene Expression Regulation
- Hepcidins/blood
- Hepcidins/genetics
- Humans
- Iron/blood
- Transcription Factors/blood
- Transcription Factors/genetics
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29
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Wu B, Wang W, Li F, Cheng Y. Angioimmunoblastic T-cell lymphomas presenting as autoimmune hemolytic anemias: clinical manifestations and circulating cytokine features. Ann Hematol 2015; 94:1437-9. [PMID: 25924920 DOI: 10.1007/s00277-015-2386-z] [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] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Boting Wu
- Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China
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30
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Fassbinder W, Koch KM. A specific immunohaemolytic anaemia induced by formaldehyde sterilisation of dialysers. Contrib Nephrol 2015; 36:51-67. [PMID: 6839775 DOI: 10.1159/000407581] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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31
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Masutani H, Okuwaki K, Kida M, Yamauchi H, Imaizumi H, Miyazawa S, Iwai T, Takezawa M, Koizumi W. First case of IgG4-related sclerosing cholangitis associated with autoimmune hemolytic anemia. World J Gastroenterol 2014; 20:8740-8744. [PMID: 25024635 PMCID: PMC4093730 DOI: 10.3748/wjg.v20.i26.8740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/01/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
To our knowledge, patients with immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) associated with autoimmune hemolytic anemia (AIHA) have not been reported previously. Many patients with IgG4-SC have autoimmune pancreatitis (AIP) and respond to steroid treatment. However, isolated cases of IgG4-SC are difficult to diagnose. We describe our experience with a patient who had IgG4-SC without AIP in whom the presence of AIHA led to diagnosis. The patient was a 73-year-old man who was being treated for dementia. Liver dysfunction was diagnosed on blood tests at another hospital. Imaging studies suggested the presence of carcinoma of the hepatic hilus and primary sclerosing cholangitis, but a rapidly progressing anemia developed simultaneously. After the diagnosis of AIHA, steroid treatment was begun, and the biliary stricture improved. IgG4-SC without AIP was thus diagnosed.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Biomarkers/blood
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis, Sclerosing/blood
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/drug therapy
- Cholangitis, Sclerosing/immunology
- Glucocorticoids/therapeutic use
- Humans
- Immunoglobulin G/blood
- Male
- Prednisolone/therapeutic use
- Tomography, X-Ray Computed
- Treatment Outcome
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32
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Sekiguchi Y, Shimada A, Imai H, Wakabayashi M, Sugimoto K, Nakamura N, Sawada T, Komatsu N, Noguchi M. A case of recurrent autoimmune hemolytic anemia during remission associated with acute pure red cell aplasia and hemophagocytic syndrome due to human parvovirus B19 infection successfully treated by steroid pulse therapy with a review of the literature. Int J Clin Exp Pathol 2014; 7:2624-2635. [PMID: 24966977 PMCID: PMC4069955] [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] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
The patient was a 47-year-old man diagnosed as having autoimmune hemolytic anemia (AIHA) in April 2011. He also had a congenital chromosomal abnormality, a balanced translocation. Treatment with prednisolone (PSL) 60 mg/day resulted in resolution of the AIHA, and the treatment was completed in November 2011. While the patient no longer had anemia, the direct and indirect Coombs tests remained positive. In May 2013, he developed recurrent AIHA associated with acute pure red cell aplasia (PRCA) and hemophagocytic syndrome (HPS) caused by human parvovirus B19 (HPV B19) infection. Tests for anti-erythropoietin and anti-erythropoietin receptor antibodies were positive. Steroid pulse therapy resulted in resolution of the AIHA, PRCA, as well as HPS. The serum test for anti-erythropoietin antibodies also became negative after the treatment. However, although the serum was positive for anti-HPV B19 IgG antibodies, the patient continued to have a low CD4 lymphocyte count (CD4, <300/μL) and persistent HPV B19 infection (HPV B19 DNA remained positive), suggesting the risk of recurrence and bone marrow failure.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Aged
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/virology
- Biomarkers/blood
- Bone Marrow Examination
- CD4 Lymphocyte Count
- Child
- Female
- Glucocorticoids/administration & dosage
- Humans
- Infant
- Lymphohistiocytosis, Hemophagocytic/blood
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphohistiocytosis, Hemophagocytic/immunology
- Lymphohistiocytosis, Hemophagocytic/virology
- Male
- Middle Aged
- Parvoviridae Infections/blood
- Parvoviridae Infections/diagnosis
- Parvoviridae Infections/drug therapy
- Parvoviridae Infections/immunology
- Parvoviridae Infections/virology
- Parvovirus B19, Human/immunology
- Parvovirus B19, Human/pathogenicity
- Prednisolone/administration & dosage
- Pulse Therapy, Drug
- Recurrence
- Red-Cell Aplasia, Pure/blood
- Red-Cell Aplasia, Pure/diagnosis
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/immunology
- Red-Cell Aplasia, Pure/virology
- Remission Induction
- Serologic Tests
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Young Adult
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Affiliation(s)
| | - Asami Shimada
- Department of Hematology, Juntendo University Urayasu HospitalJapan
| | | | | | - Keiji Sugimoto
- Department of Hematology, Juntendo University Urayasu HospitalJapan
| | - Noriko Nakamura
- Department of Clinical Laboratory, Juntendo University Urayasu HospitalJapan
| | - Tomohiro Sawada
- Department of Clinical Laboratory, Juntendo University Urayasu HospitalJapan
| | - Norio Komatsu
- Department of Hematology, Juntendo University HospitalJapan
| | - Masaaki Noguchi
- Department of Hematology, Juntendo University Urayasu HospitalJapan
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33
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Bajpayee A, Dubey A, Verma A, Chaudhary RK. A report of a rare case of autoimmune haemolytic anaemia in a patient with Hodgkin's disease in whom routine serology was negative. Blood Transfus 2014; 12 Suppl 1:s299-s301. [PMID: 23736924 PMCID: PMC3934223 DOI: 10.2450/2013.0292-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/23/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Archana Bajpayee
- Correspondence: Archana Bajpayee, Department of Transfusion Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India, e-mail:
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34
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Singh A, Solanki A, Chaudhary R. Demonstration of IgG subclass (IgG1 and IgG3) in patients with positive direct antiglobulin tests. Immunohematology 2014; 30:24-27. [PMID: 25238241] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Serologic characterization of autoantibodies helps in the management and monitoring of the course of autoimmune hemolytic anemia (AIHA). The purpose of this study was to evaluate gel centrifugation test (GCT) cards for immunoglobulin G (IgG) titer and determination of IgG subclasses IgG1 and IgG3 and their influence on hemolysis. Eighty direct antiglobulin test (DAT)-positive patients were examined with the help of GCT cards for IgG titer and IgG subclasses. The results were correlated with the presence and absence of hemolysis. A statistically significant (p < 0.005) association of hemolysis with increasing anti-IgG titer was observed. When IgG titer was 30 or less, 28 (50.91%) patients had no hemolysis, whereas 15 (93.75%) patients had features of hemolysis when titer was at least 300. Statistically significant (p < 0.005) association of subclass of IgG (IgG1, IgG3) coating the red blood cells with intravascular hemolysis was also seen. Twenty-nine (80.56%) patients had evidence of hemolysis when IgG1 or IgGl-IgG3 both were present. Gel technology is helpful to demonstrate red blood cell-bound autoantibodies and their characterization with regard to class, subclass, and titer. This information is useful to identify patients with AIHA who are at risk of severe hemolysis with adverse prognosis.
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Affiliation(s)
| | | | - R Chaudhary
- MD (corresponding author), Professor and Head, Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow 226014, India
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Arndt PA, Leger RM. Introduction to immunohematology special edition on drug-induced immune cytopenias. Immunohematology 2014; 30:43. [PMID: 25350999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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36
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Barron C. Allogeneic red blood cell adsorption for removal of warm autoantibody. Immunohematology 2014; 30:153-155. [PMID: 25831261] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Adsorption studies are usually required to confirm or rule out the presence of underlying alloantibodies in samples containing warm autoantibody. Allogeneic adsorptions are necessary if the patient has been recently transfused. Most commonly, allogeneic adsorptions are performed using a trio of phenotyped reagent red blood cells to rule out clinically significant alloantibodies to common antigens. The adsorbing cells may be used untreated or treated with enzymes or with ZZAP before adsorption. Adsorption may also be performed using enhancement such as low-tonic strength saline or polyethylene glycol added to the mixture. Multiple adsorptions may be necessary to remove strongly reactive autoantibodies. Allogeneic adsorptions will not detect alloantibodies to high-prevalence antigens.
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Affiliation(s)
- Christina Barron
- MT(ASCP)SBB, Manager, Immunohematology Reference Laboratory, American Red Cross, Missouri-Illinois Region, 4050 Lindell, St. Louis, MO 63108
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de Witte MA, Determann RM, Zeerleder SS. A man with "black fingers". Cold agglutinin disease (CAD). Neth J Med 2014; 72:35-40. [PMID: 24457440] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- M A de Witte
- Department of Haematology, Academic Medical Centre, Amsterdam, the Netherlands
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Abstract
A 59-year-old woman was referred to our hospital because of severe anemia and leucopenia. Although she developed mild arthralgia without the typical symptoms of systemic lupus erythematosus (SLE), positivity for anti-Sm antibodies led us to a diagnosis of late-onset SLE. Autoimmune hemolytic anemia (AIHA) and suppression of reticulocyte production were considered to have been involved in the etiology of severe anemia. Administration of oral prednisolone (PSL) resulted in a marked improvement of the hematological abnormalities. As late-onset SLE is rare and patients tend to show the typical symptoms less frequently, close attention should be focused on latent symptoms and immunological findings.
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MESH Headings
- Administration, Oral
- Age of Onset
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/immunology
- Antibodies, Antinuclear/blood
- Arthralgia/etiology
- Biomarkers/blood
- Female
- Glucocorticoids/administration & dosage
- Humans
- Leukopenia/etiology
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/immunology
- Middle Aged
- Prednisolone/administration & dosage
- Severity of Illness Index
- Time Factors
- Treatment Outcome
- snRNP Core Proteins/immunology
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Affiliation(s)
- Moeko Matsumoto
- Department of Medicine, Kurume University School of Medicine
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Korkmaz H, Bugdaci MS, Temel T, Dagli M, Karabagli P. Autoimmune hepatitis-primary biliary cirrhosis overlap syndrome concomitant with immune hemolytic anemia and immune thrombocytopenic purpura (Evans syndrome). Clin Res Hepatol Gastroenterol 2013; 37:e45-50. [PMID: 23273499 DOI: 10.1016/j.clinre.2012.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 09/18/2012] [Revised: 11/03/2012] [Accepted: 11/06/2012] [Indexed: 02/04/2023]
Abstract
Autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) associated with Evans syndrome; combination of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP) has rarely been reported. We report the case of a 53-year-old patient who presented with weakness, myalgia, arthralgia, shortness of breath and purpura. Initial laboratory investigations revealed liver dysfunction, anemia and thrombocytopenia. Anti-nuclear (ANA) and antimitochondrial M2 (AMA M2) antibodies were positive. Diagnose of PBC-AIH overlap was made by clinical, serological and histological investigations. AIHA and ITP was identified with clinical-laboratory findings and bone marrow puncture. She was treated with IVIG followed by prednisolone and ursodeoxycholic acid. Hemoglobin-thrombocytes increased rapidly and transaminases improved at day 8. We have reported the first case in the literature with AIH-PBC overlap syndrome concurrent by ITP and AIHA which suggest the presence of shared genetic susceptibility factors in multiple autoimmune conditions including AIH, PBC, ITP and AIHA.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Antibodies, Antinuclear/blood
- Autoantibodies/blood
- Cholagogues and Choleretics/therapeutic use
- Female
- Glucocorticoids/therapeutic use
- Hepatitis, Autoimmune/blood
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/drug therapy
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Liver Cirrhosis, Biliary/blood
- Liver Cirrhosis, Biliary/diagnosis
- Liver Cirrhosis, Biliary/drug therapy
- Middle Aged
- Mitochondria, Liver/immunology
- Prednisolone/therapeutic use
- Thrombocytopenia/blood
- Thrombocytopenia/diagnosis
- Thrombocytopenia/drug therapy
- Ursodeoxycholic Acid/therapeutic use
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Affiliation(s)
- Huseyin Korkmaz
- Selcuk University, Selcuklu medical faculty, department of internal medicine division of Gastroenterohepatology, Selcuklu, Konya, Turkey.
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Bercovitz RS, Macy M, Ambruso DR. A case of autoimmune hemolytic anemia with anti-D specificity in a 1-year-old child. Immunohematology 2013; 29:15-18. [PMID: 24046918 PMCID: PMC4164528] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although antibodies to antigens in the Rh blood group system are common causes of warm autoimmune hemolytic anemia, specificity for only the D antigen is rare in autoimmune hemolysis in pediatric patients. This case reports an anti-D associated with severe hemolytic anemia (Hb = 2.1 g/dL) in a previously healthy 14-month-old child who presented with a 3-day history of low-grade fevers and vomiting. Because of his severe anemia, on admission to the hospital he was found to have altered mental status, metabolic acidosis, abnormal liver function tests, and a severe coagulopathy. He was successfully resuscitated with uncrossmatched units of group O, D- blood, and after corticosteroid therapy he had complete resolution of his anti-D-mediated hemolysis.
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Affiliation(s)
- Rachel S. Bercovitz
- Bonfils Blood Center, Denver, CO
- The University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
| | - Margaret Macy
- The University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
| | - Daniel R. Ambruso
- Bonfils Blood Center, Denver, CO
- The University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
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Heiligers-Duckers C, Werner PT, van Drunen MEP. [Reticulocytes in the diagnosis of anaemia]. Ned Tijdschr Geneeskd 2013; 157:A6313. [PMID: 24382033] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Reticulocytes are immature erythrocytes; the number of reticulocytes in the peripheral blood reflects erythropoietic activity. Two cases are described to illustrate the use of the reticulocyte count in the diagnostic workup of anaemia. The first patient was a 62-year-old woman presenting with fatigue. Laboratory evaluation showed severe macrocytic anaemia, thrombocytopaenia and the presence of schistocytes. A low reticulocyte count suggested decreased erythropoiesis underlying the anaemia; this led to the diagnosis of vitamin B12 deficiency. The second patient, a 52-year-old woman, also presented with fatigue and macrocytic anaemia. A high reticulocyte count indicated increased erythrocyte degradation, and the patient was eventually diagnosed with autoimmune haemolytic anaemia. The role of reticulocytes in the differential diagnostic workup of anaemia was explored on the basis of these case descriptions. The test methodology, analytical performance, reference values and pitfalls were discussed, as well as the reticulocyte indices and their use in monitoring therapy.
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Hopkins C, Walters TK. Thermal amplitude test. Immunohematology 2013; 29:49-50. [PMID: 24094235] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The thermal amplitude test is performed to determine the reactivity of a cold autoantibody at varying temperatures: 4° C, 22° C, 30° C, and 37° C. Cold autoantibodies that are reactive at temperatures greater than 30° C have the potential to be clinically significant regardless of the antibody titer. Cold antibodies that are reactive at temperatures less than 30° C are not considered to be clinically significant.
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Zantek ND, Koepsell SA, Tharp DR, Cohn CS. The direct antiglobulin test: a critical step in the evaluation of hemolysis. Am J Hematol 2012; 87:707-9. [PMID: 22566278 DOI: 10.1002/ajh.23218] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 03/22/2012] [Accepted: 03/25/2012] [Indexed: 11/11/2022]
Abstract
The direct antiglobulin test (DAT) is a laboratory test that detects immunoglobulin and/or complement on the surface of red blood cells. The utility of the DAT is to sort hemolysis into an immune or nonimmune etiology. As with all tests, DAT results must be viewed in light of clinical and other laboratory data. This review highlights the most common clinical situations where the DAT can help classify causes of hemolysis, including autoimmune hemolytic anemia, transfusion-related hemolysis, hemolytic disease of the fetus/newborn, drug-induced hemolytic anemia, passenger lymphocyte syndrome, and DAT-negative hemolytic anemia. In addition, the pitfalls and limitations of the test are addressed. False reactions may occur with improper technique, including improper washing, centrifugation, and specimen agitation at the time of result interpretation. Patient factors, such as spontaneous red blood cell agglutination, may also contribute to false results.
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MESH Headings
- Adult
- Anemia, Hemolytic/blood
- Anemia, Hemolytic/chemically induced
- Anemia, Hemolytic/diagnosis
- Anemia, Hemolytic/prevention & control
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Congenital/blood
- Anemia, Hemolytic, Congenital/diagnosis
- Blood Group Incompatibility/prevention & control
- Coombs Test
- Hemolysis/drug effects
- Humans
- Infant, Newborn
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Affiliation(s)
- Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/therapy
- Anemia, Myelophthisic/etiology
- Autoantibodies/analysis
- Blood Transfusion
- Child, Preschool
- Coombs Test
- Cytophagocytosis
- Erythrocyte Aggregation
- Erythrocyte Indices
- Female
- Fever/etiology
- Hematuria/etiology
- Hemoglobinuria, Paroxysmal/blood
- Hemoglobinuria, Paroxysmal/diagnosis
- Hemoglobinuria, Paroxysmal/therapy
- Humans
- Hyperbilirubinemia/etiology
- L-Lactate Dehydrogenase/blood
- Neutrophils/pathology
- Spherocytes/pathology
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Affiliation(s)
- Vandana Bharadwaj
- Department of Paediatric Haematology, St Mary's Hospital, Praed Street, London, UK
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45
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Feng Q, Zak D, Daya R. Autoimmune hemolytic anemia and classical Hodgkin lymphoma: a case report and literature review. Clin Adv Hematol Oncol 2012; 10:270-276. [PMID: 22706493] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
MESH Headings
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/therapy
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents, Hormonal/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bleomycin/therapeutic use
- Dacarbazine/therapeutic use
- Doxorubicin/therapeutic use
- Erythrocyte Transfusion
- Hodgkin Disease/complications
- Hodgkin Disease/drug therapy
- Hodgkin Disease/pathology
- Humans
- Male
- Middle Aged
- Prednisone/therapeutic use
- Rituximab
- Vinblastine/therapeutic use
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Affiliation(s)
- Qi Feng
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York, USA.
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Al-Sayes FM, Hindawi SI, Damanhouri GA, Attallah SM, Azaher FA, Akbar DH. Autoimmune thrombocytopenia. Is it a different disease or different aspects of a single disease? Saudi Med J 2012; 33:182-185. [PMID: 22327760] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To evaluate the association between autoimmune thrombocytopenia with other autoimmune disorders, to show if they are different autoimmune diseases or one disease with different presentations at the same time, and to study the effect of treatment on platelet count in different thyroid condition. METHODS In this retrospective study, we included 141 patients with thrombocytopenic purpura. The result of thyroid function test, thyroid autoantibodies, Coombs' reactivity, anti-nuclear antibody, and double-stranded DNA were analyzed. This study was conducted in the Clinical Hematology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between June 2003 and August 2010. RESULTS There were 51 (36.2%) patients with laboratory evidence of autoimmune disease, 13 (9.2%) with hypothyroidism, and 6 (4.3%) with hyperthyroidism. In addition, 5 (3.5%) patients showed laboratory evidence of Evan syndrome and 3 (2.1%) patients had isolated positive thyroid antibodies. There was non-significant difference (p=0.61) in platelets count after one month of treatment of patients with different thyroid condition. CONCLUSION Immune thrombocytopenia is associated with evidence of different autoimmune disease or a combination of them, which may appear at presentation or during the course of disease giving evidence that they are different manifestations of a single disease. Screening patients for antithyroid antibodies would identify a patient at risk of developing overt thyroid disease. These patients may be further screened with a thyroid-stimulating hormone assay to detect subclinical thyroid disease.
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MESH Headings
- Adolescent
- Adult
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/immunology
- Antibodies, Antinuclear/blood
- Antibodies, Antinuclear/immunology
- Autoantibodies/blood
- Autoantibodies/immunology
- Autoimmune Diseases/blood
- Autoimmune Diseases/immunology
- Child
- Coombs Test
- Female
- Humans
- Hyperthyroidism/blood
- Hyperthyroidism/immunology
- Hypothyroidism/blood
- Hypothyroidism/immunology
- Male
- Middle Aged
- Platelet Count
- Purpura, Thrombocytopenic, Idiopathic/blood
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Retrospective Studies
- Saudi Arabia
- Thrombocytopenia/blood
- Thrombocytopenia/immunology
- Thyroid Diseases/immunology
- Thyroid Diseases/metabolism
- Thyroid Gland/immunology
- Thyroid Gland/metabolism
- Thyrotropin/blood
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Affiliation(s)
- Fatin M Al-Sayes
- Hematology Department, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Zhou XL, Yan S, Li P, Zhao YP. [Application of micro-column gel cards assay for direct Coombs test in diagnosis of autoimmune hemolytic anemia]. Zhonghua Xue Ye Xue Za Zhi 2012; 33:31-33. [PMID: 22575189] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the clinic value of micro-column gel cards direct Coombs test (gel test) in diagnosis of autoimmune hemolytic anemia (AIHA). METHODS Specimens of 128 suspected AIHA patients were performed direct Coombs test by conventional tube or gel cards. The results of the two tests were compared. The hemoglobin concentrations, proportions of reticulocyte, serum levels of bilirubin and free hemoglobin were detected simultaneously and compared in subgroups. RESULTS The positive detection rate of direct Coombs test performed by gel test or tube were 88.4% and 37.7%, respectively. CONCLUSION Compared with the tube tests, gel test assay is more sensitive, easy to perform and standardized in diagnosis of AIHA, and the gel card can be stored for a long time. The gel test is valuable for the diagnosis of AIHA.
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Affiliation(s)
- Xue-li Zhou
- Department of Blood Transfusion, Chinese Academy of Medical Sciences, Tianjin, China
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Thedsawad A, Taka O, Wanachiwanawin W. Development of flow cytometry for detection and quantitation of red cell bound immunoglobulin G in autoimmune hemolytic anemia with negative direct Coombs test. Asian Pac J Allergy Immunol 2011; 29:364-367. [PMID: 22299318] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
About 2-10% of patients with warm-antibody autoimmune hemolytic anemia (WAIHA) exhibit a negative direct Coombs test (DAT), requiring more sensitive tests, including detection of RBC-bound immunoglobulins by flow cytometry, for diagnosis. In this study, the optimal conditions for detection and quantitation of RBC-bound IgG by flow cytometry were studied using blood samples from six patients with AIHA and two healthy individuals. Quantitation of RBC-bound IgG was performed using quantum simply cellular (QSC) beads coated with goat anti-mouse IgG antibodies. For detection of RBC bound IgG, a 60-minute incubation of all blood samples with 40 microl of 1:10 dilution of FITC-conjugated mouse anti-human IgG gave mean fluorescent intensity (MFI) values comparable to experiments using larger amounts or higher concentrations of the anti-human IgG. The acquired antibody binding capacity (ABC) values (or IgG molecules) for each QSC bead level, at 40 microl of 1:5 and 1:10 dilution of anti-human IgG for 60 minutes were close to the manufacturer-assigned ABC values. The IgG molecules per RBC in all six patients with positive DAT of 4+, 3+, 2+, 1+, trace and negative DAT were 31,725, 3,823, 1,753, 524, 260 and 88 respectively and in two healthy individuals with negative DAT they were 104 and 78.
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Affiliation(s)
- Anchalee Thedsawad
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
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Gonzalez-Nieto JA, Martin-Suarez I, Quattrino S, Ortiz-Lopez E, Muñoz-Beamud FR, Colchero-Fernández J, Alcoucer-Diaz MR. The efficacy of romiplostim in the treatment of severe thrombocytopenia associated to Evans syndrome refractory to rituximab. Lupus 2011; 20:1321-3. [PMID: 21719526 DOI: 10.1177/0961203311404913] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We present a case of a man diagnosed with systemic lupus erythematosus, associated antiphospholipid syndrome and Evans syndrome, who developed a severe thrombocytopenia refractory to treatment with first-line drugs, cyclophosphamide and rituximab, and who responded to romiplostim with a normalization of the platelet recount, which later enabled a therapeutic splenectomy to be performed.
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MESH Headings
- Adult
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/surgery
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antiphospholipid Syndrome/complications
- Antiphospholipid Syndrome/drug therapy
- Cyclophosphamide/therapeutic use
- Humans
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Male
- Platelet Count
- Receptors, Fc/therapeutic use
- Recombinant Fusion Proteins/therapeutic use
- Rituximab
- Splenectomy
- Thrombocytopenia/blood
- Thrombocytopenia/complications
- Thrombocytopenia/drug therapy
- Thrombocytopenia/etiology
- Thrombocytopenia/surgery
- Thrombopoietin/therapeutic use
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Affiliation(s)
- J A Gonzalez-Nieto
- Autoimmune Diseases Unit, Internal Medicine Department, Juan Ramón Jimenez Hospital, Huelva, Spain
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50
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Zhou QN, Xing LM, Fu R, Wang HQ, Liu H, Li LJ, Ruan EB, Zhang T, Qu W, Wu YH, Song J, Guan J, Wang J, Shao ZH. [Count and function of CD8(+)CXCR3(+) regulatory T cells in peripheral blood of patients with autoimmune hemolytic anemia]. Zhonghua Yi Xue Za Zhi 2011; 91:1687-1690. [PMID: 21914317] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the effects of CD8(+)CXCR3(+)T cells on autoimmune hemolytic anemia (AIHA). METHODS Twenty-two AIHA patients, including 11 untreated and 11 recovered ones, and 23 normal controls were recruited from July 2010 to November 2010. The percentage of CD8(+)CXCR3(+)/CD8(+)T cells in peripheral blood and the expression of interleukin-10 (IL-10) in CD8(+)CXCR3(+)T cells were detected by flow cytometry. Their correlations with the count of CD3(+)CD4(+)cells and the percentage of CD5(+)CD19(+) in CD19(+) B cells were analyzed. The expression level of CXCR3 mRNA in PBMC was determined by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). RESULTS The percentage of CD8(+)CXCR3(+)/CD8(+) of untreated AIHA patients was (39.80 ± 19.96)%. And it was lower than that of recovered patients [(58.76 ± 14.22)%, P < 0.05] and normal controls [(59.66 ± 12.62)%, P < 0.01]. The percentage of IL-10(+) T cells in CD8(+)CXCR3(+)T cells of untreated patients was (22.98 ± 14.96)% and it was lower than that of normal controls [(38.15 ± 17.03)%, P < 0.05]. The expression level of CXCR3 mRNA for untreated AIHA patients was (0.51 ± 0.19) and it was lower than that of normal controls (1.67 ± 1.17, P < 0.01). The percentage of CD8(+)CXCR3(+)/CD8(+)T cells had a negative correlation with the count of CD3(+)CD4(+) cells and the percentage of CD5(+)CD19(+)/CD19(+) B cells (r = -0.571, -0.583, both P < 0.05). So did the percentage of IL-10(+) T cells in CD8(+)CXCR3(+)T cells (r = -0.524, -0.523, both P < 0.05). CONCLUSION The decreased count of CD8(+)CXCR3(+)T cells and the lowered level of IL-10 may disturb the immune tolerance and lead to the occurrence of AIHA.
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Affiliation(s)
- Qian-na Zhou
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China
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