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Hayasi T, Kayashima K, Okura D, Kawasaki T. [Blood Transfusion in a Patient with Severe Anemia and Immunoglobulin A Deficiency during an Emergency Total Hysterectomy on a Holiday]. Masui 2016; 65:1051-1053. [PMID: 30358287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 45-year-old woman diagnosed with immunoglobu- lin A (IgA) deficiency during blood donation and undiagnosed with anti-IgA antibodies possession underwent emergency total abdominal hysterectomy due to bleeding from the uterus. The patient needed washed red blood cell (RBC) transfusion to avoid severe reaction to blood transfusion. However, Kitakyushu's Blood Center could not supply adequate RBCs immedi- ately because it was a holiday. The patient her rela- tives, and medical staff decided to use 4 units of trans- fused unwashed RBC to increase-her hemoglobin level from 5.4 to 6.5 g - d1- before anesthesia. We prepared an autologous blood collection device and started anes- thesia. Intraoperatively, 155 g bleeding was noted, and the patient was discharged uneventfully. Selective IgA deficiency is the most common primary hypogamma- globulinemia and is less frequent in the Japanese than in Caucasians. Up to 40% of patients with IgA defi- ciency had anti-IgA antibodies that can cause anaphy- lactic reactions to IgA in transfused blood. Blood cen- ters usually maintain a list of IgA-deficient blood donors to prepare compatible blood components. Wash- ing can remove>99% IgA in blood components that may prevent anaphylaxis. Blood transfusion in the present case might have generated anti-IgA antibodies. The patient would need washed RBCs in a subsequent operation.
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Kronbichler A, Frank R, Kirschfink M, Szilágyi Á, Csuka D, Prohászka Z, Schratzberger P, Lhotta K, Mayer G. Efficacy of eculizumab in a patient with immunoadsorption-dependent catastrophic antiphospholipid syndrome: a case report. Medicine (Baltimore) 2014; 93:e143. [PMID: 25474424 PMCID: PMC4616391 DOI: 10.1097/md.0000000000000143] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Catastrophic antiphospholipid syndrome (CAPS) is a rare but devastating complication in patients with antiphospholipid syndrome (APS) with a high morbidity and mortality.We describe a case of a 30-year old female patient with immunoglobulin A (IgA) deficiency who underwent splenectomy because of idiopathic thrombocytopenic thrombocytopenia. Subsequently, an APS and finally systemic lupus erythematosus was diagnosed. After an uncomplicated pregnancy that was terminated by cesarean section, the patient developed severe CAPS with cerebral, myocardial, renal, and pulmonary involvement.Because of IgA deficiency, standard therapy consisting of plasmapheresis and intravenous immunoglobulins in addition to steroids was not tolerated. After 8 sessions of immunoadsorption (IAS), massive pulmonary hemorrhage was controlled but relapsed twice whenever IAS was terminated. As other immunosuppressive agents were considered dangerous because of the risk of infections in the face of severe hypogammaglobulinemia, we administered eculizumab, an inhibitor of the terminal complement pathway, which led to a persistent control of her disease. Interestingly, eculizumab therapy was associated with a further decline of complement C3 and C4 serum levels. The patient developed a subsequent flare of her systemic lupus erythematosus, potentially indicating that complement inhibition by eculizumab is not effective in preventing lupus flares.Taken together, we describe a unique case of life-threatening and difficult-to-treat CAPS with a good clinical response after terminal complement complex inhibition with eculizumab. Further controlled trials are necessary to investigate the value of eculizumab in patients with CAPS.
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Affiliation(s)
- Andreas Kronbichler
- From the Department of Internal Medicine IV (Nephrology and Hypertension) (AK, PS, GM); Department of Radiology (RF), Medical University Innsbruck, Innsbruck, Austria; Institute of Immunology (MK), University of Heidelberg, Heidelberg, Germany; 3rd Department of Medicine (AS, DC, ZP), Research Laboratory, Faculty of Medicine, Semmelweis University, Budapest, Hungary; and Department of Nephrology and Dialysis (KL), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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El Bakkouri J, Aadam Z, Ailal F, Alj HS, Bousfiha AA. [Humoral immunodeficiency : awareness for better support]. Pan Afr Med J 2014; 18:272. [PMID: 25489366 PMCID: PMC4258215 DOI: 10.11604/pamj.2014.18.272.4061] [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] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/07/2014] [Indexed: 11/11/2022] Open
Abstract
Les déficits immunitaires humoraux (DIH) sont des maladies hétérogènes allant des formes asymptomatiques rencontrés lors des déficits sélectifs en immunoglobulines A (IgA) et en sous-classes d'IgG aux formes graves des agammaglobulinémies congénitales. Les patients atteints de DIH présentent souvent des infections ORL ou des voies respiratoires récidivantes ou sévères. Ces patients peuvent présenter un certain nombre de complications non infectieuses, telles que des manifestations auto-immunes et des entéropathies, qui pourraient être le seul symptôme clinique révélateur. Les formes sévères des DIH sont facilement diagnostiquées grâce au dosage des IgG totaux, des IgA et des IgM. La thérapie substitutive par les immunoglobulines reste le traitement de choix chez ces patients.
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Affiliation(s)
- Jalila El Bakkouri
- Laboratoire d'Immunologie, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc ; Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
| | - Zahra Aadam
- Laboratoire de Recherche Biologie et Santé, Faculté des Sciences Ben M'sik, Université Hassan II, Casablanca, Maroc
| | - Fatima Ailal
- Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc ; Unité d'Immunologie Clinique, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
| | - Hanane Salih Alj
- Laboratoire de Recherche Biologie et Santé, Faculté des Sciences Ben M'sik, Université Hassan II, Casablanca, Maroc
| | - Ahmed Aziz Bousfiha
- Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc ; Unité d'Immunologie Clinique, Centre Hospitalier Universitaire Ibn Rochd, Casablanca, Maroc
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Troitskaya EV, Sofronova LV, Tsvetkova TY. [Primary immunodeficiencies are a topical problem of modern medicine]. TERAPEVT ARKH 2014; 86:12-15. [PMID: 25715480] [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: 06/04/2023]
Abstract
AIM To analyze the incidence of primary immunodeficiencies (PIDs), to reveal the specific features of the course of this condition at the present stage, and to estimate the quality of health care to patients with PIDs. SUBJECTS AND METHODS An open-label prospective trial was performed in 94 patients with different forms of PIDs (63 with selective immunoglobulin A (IgA) deficiency and 31 with other more severe primary immunodeficiencies) who had been permanent residents in the Perm Territory in the period 1990 to 2012. RESULTS The registered PID cases were noted to be lower than the estimated ones. Over 22 years of follow-ups, the death rates for this group of patients with these diseases were 11%, and the disability rates were 27%. In severe PIDs (exclusive of selective IgA deficiency), these rates were as high as 35.5 and 96%, respectively. The rate of untimely diagnosis of severe PIDs was high (43%). Molecular genetic studies were conducted in only one tenth of the patents with this disease. PID treatment generally complied with the accepted medical standards. However, all patients with X-linked agammaglobulinemia were observed to have periodic irregularities of replacement therapy with intravenous immunoglobulins, which was a cause of death in 2 patients. Adult patients with common variable immune deficiency received no adequate replacement therapy. Timely diagnosis and adequate therapy could not only preserve the life of many patients with severe PIDs (64.5% survived), but could achieve its relatively satisfactory quality. CONCLUSION As of now, PIDs ceased to be fatal diseases. To improve the quality of health care to patients with this pathology, there is a need to increase the awareness of the diagnosis and treatment of immunodeficiencies among physicians of different specialties, to extend the application of molecular genetic techniques, including those for prenatal diagnosis, and to continuously provide patients with essential drugs.
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Binek A, Jarosz-Chobot P. [Selective immunoglobulin A deficiency]. Pediatr Endocrinol Diabetes Metab 2012; 18:76-78. [PMID: 22781885] [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: 06/01/2023]
Abstract
Immunoglobulin class A is the main protein of the mucosal immune system. Selective immunoglobulin A deficiency (sIgAD) is the most common primary immunodeficiency in Caucasians. sIGAD is strongly associated with the certain major histocompatibility complex region. Most individuals with sIgAD are asymptomatic and identified coincidentally. However, some patients may present with recurrent infections, allergic disorders and autoimmune manifestations. Several autoimmune diseases, such as systemic lupus erythematosus, diabetes mellitus type 1, Graves disease and celiac disease, are associated with an increased prevalence of sIgAD. Screening for sIgAD in coeliac disease is essential. Patients need treatment of associated diseases. It is also known that IgA deficiency may progress into a common variable immunodeficiency (CVID). Pathogenesis and molecular mechanism involved in sIgAD should be elucidated in the future.
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Affiliation(s)
- Alicja Binek
- Oddzial Pediatrii, Endokrynologii i Diabetologii Dzieciecej Gornoslaskiego Centrum Zdrowia Dziecka w Katowicach.
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Elizabeth KE. Bovine colostrum in those with immunodeficiency. Indian Pediatr 2009; 46:817-819. [PMID: 19812430] [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: 05/28/2023]
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Marwaha N. IgA deficiency: implications for transfusion. Indian J Med Res 2006; 123:591-2. [PMID: 16873901] [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: 05/11/2023] Open
Affiliation(s)
- Neelam Marwaha
- Department of Transfusion Medicine Postgraduate Institute of Medical Education and Research Chandigarh 160012, India.
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Husain Z, Holodick N, Day C, Szymanski I, Alper CA. Increased apoptosis of CD20+ IgA + B cells is the basis for IgA deficiency: the molecular mechanism for correction in vitro by IL-10 and CD40L. J Clin Immunol 2006; 26:113-25. [PMID: 16758339 DOI: 10.1007/s10875-006-9001-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 10/24/2005] [Indexed: 10/24/2022]
Abstract
IgA deficiency is the most common primary immunodeficiency in humans. Comparative analysis of gene expression in PBMC from IgA-deficient (IgAd) and normal donors using functional multiplex panels showed overexpression of the Caspase-1 (CASP-1) gene. Cells from all the IgAd donors (n=7) expressed 4-10-fold caspase-1 mRNA over normal controls (n=5). CD19(+) B cells from all IgAd donors produced IgA in cultures following IL-10 and CD40L with Staphylococcus aureus (Cowan) (SAC) or tetanus toxoid (TT) treatments. In CD19(+) B cells from IgAd donors, reconstitution of IgA secretion was associated with protection of the CD20(+) B cell population that underwent apoptosis in the absence of IL-10, CD40L, and TT (triple treatment). Caspase-1 gene expression was decreased in the reconstituted cells. Furthermore, treatment with a caspase-1 inhibitor also independently protected against B cell apoptosis in vitro. An apoptosis-specific cDNA array showed differential expression of 4 out of 96 genes and a shift towards survival-related gene expression from the apoptotic to the protected B cells after triple treatment. There was an increase in the expression of the IAP-2 (inhibitor of apoptosis) gene in the reconstituted cells. Upregulation of the IAP-2 gene protects B cells from deletion and allows for IgA secretion in this system. The inability to detect secreted IgA in IgAd patients could result from the loss of IgA-committed B cells that express high levels of caspase-1.
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Affiliation(s)
- Zaheed Husain
- The CBR Institute for Biomedical Research, Boston, Massachusetts 02115, USA
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Cooper MA, Pommering TL, Korányi K. Primary immunodeficiencies. Am Fam Physician 2003; 68:2001-8. [PMID: 14655810] [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: 04/27/2023]
Abstract
Primary immunodeficiencies include a variety of disorders that render patients more susceptible to infections. If left untreated, these infections may be fatal. The disorders constitute a spectrum of more than 80 innate defects in the body's immune system. Primary immunodeficiencies generally are considered to be relatively uncommon. There may be as many as 500,000 cases in the United States, of which about 50,000 cases are diagnosed each year. Common primary immunodeficiencies include disorders of humoral immunity (affecting B-cell differentiation or antibody production), T-cell defects and combined B- and T-cell defects, phagocytic disorders, and complement deficiencies. Major indications of these disorders include multiple infections despite aggressive treatment, infections with unusual or opportunistic organisms, failure to thrive or poor growth, and a positive family history. Early recognition and diagnosis can alter the course of primary immunodeficiencies significantly and have a positive effect on patient outcome.
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Affiliation(s)
- Megan A Cooper
- The Ohio State University College of Medicine and Public Health, Columbus, Ohio, USA
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Cunningham-Rundles C. Immune deficiency: office evaluation and treatment. Allergy Asthma Proc 2003; 24:409-15. [PMID: 14763242] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Congenital deficiencies of the immune system occur in children or adults and can cause severe or recurrent infections. The overall incidence of these immunodeficiency diseases is estimated at approximately 1 in 10,000, excluding selective immunoglobulin A deficiency, but this estimation is based on population studies, not hospital or clinic populations. The majority of immune defects involve antibody production; these immune deficiencies are found more often in adults than infants and children. In an allergy practice, recurrent infections are common, and determining if an immune defect is likely to be present can be problematic. Some guidelines concerning the clinical presentation and laboratory evaluation and treatment options can aid the practicing clinician.
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Affiliation(s)
- Charlotte Cunningham-Rundles
- Department of Medicine, Pediatrics, and Immunobiology, Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029, USA
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Uram R, Rosoff PM. Isolated IgA deficiency after chemotherapy for acute myelogenous leukemia in an infant. Pediatr Hematol Oncol 2003; 20:487-92. [PMID: 14631625] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
IgA deficiency is a relatively common congenital immunodeficiency in children. It can either be asymptomatic or lead to frequent infections, most often of the sinuses and lungs. Intensive chemotherapy for acute leukemia is also profoundly immunosuppressive and can be complicated with life-threatening infections, usually associated with neutropenia and prolonged lymphopenia in the post-bone marrow transplant setting. Isolated, acquired immunoglobulin deficiency that occurs during treatment has been described but is usually transient. In this report, the authors describe a patient with infant acute myelogenous leukemia with acquired, persistent IgA deficiency.
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Affiliation(s)
- Rebecca Uram
- Division of Allergy and Immunology, Department of Pediatrics, Duke University Medical Center, Box 2916, Durham, NC 27710, USA
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Abstract
Modern donor milk banking was conceived in the US in the early 1900s as a medicalized version of wet nursing. Over the course of the century the fortunes of donor milk banking have varied considerably. In the last 20 years donor milk banking has been negatively affected by the development of specialty formulas, safety issues related to viral transmission, and lack of clinical research. To survive, US milk banks have been receptive to clinical uses considered as "alternative medicine," and have cooperated with governmental agencies to develop standards for safety. A qualitative analysis of collected case histories of US donor milk recipients demonstrates that donor human milk banking can be critical to survival and the well-being of at-risk infants, children, and the occasional adult. By analyzing national data collected by survey method and examining the literature, the researcher compared German and US milk banks and distribution data. German milk banks use donor milk exclusively for premature infants and have less stringent operating standards, yet dispense volumes of milk greatly in excess of the US milk banks. While statistics are lacking for the total recipient population in the US, a projected analysis (based on German consumption) of the potential volume that could be dispensed in the US is presented, indicating that the population in need of this crucial public health service is currently under-served in the US.
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Affiliation(s)
- L D Arnold
- The National Commission on Donor Milk Banking, Sandwich, MA 02563, USA
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Abstract
Selective IgA deficiency is the most common primary immunodeficiency, with a prevalence of approximately 1/600 in whites. Most subjects are asymptomatic but some may suffer from frequent respiratory and gastrointestinal infections. Patients who suffer from frequent infections usually have a defect in antibody responses toward polysaccharides, which is often associated with IgG2 deficiency. Genetic predisposition to develop IgA deficiency has been shown to be linked to at least one locus on 6p21. Some IgA-deficient patients are also prone to develop more severe immunodeficiency called common variable immunodeficiency, which is associated with decreased IgG and sometimes IgM production as well as partial T-cell defect. In a few cases, IgA deficiency may reveal a severe disease such as ataxia-telangiectasia. Selective IgA deficiency contraindicates immunoglobulin administration. Only the minority of IgA-deficient patients who develop severe or frequent infections in association with IgG2 deficiency or impaired antibody response are candidates for prophylactic intravenous immunoglobulin substitution. Immunoglobulin preparations containing particularly low amounts of IgA are required to avoid adverse effects related to anti-IgA alloantibodies.
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Affiliation(s)
- P Quartier
- Unité d'immunologie-hématologie pédiatrique, hôpital Necker-Enfants malades, 149, rue de Sèvres, 75743 Paris, France.
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Pipitone N, Fioravanti A, Marcolongo R, Pitzalis C. [Articular involvement in the course of primary hypogammaglobulinemia]. Recenti Prog Med 2001; 92:63-7. [PMID: 11260975] [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: 02/19/2023]
Abstract
The Authors describe the main features of the most common forms of primary hypogammaglobulinaemia (PH) focusing on the articular involvement. Patients with Bruton's agammaglobulinemia (BA) and common variable immune deficiency (CVID) are predisposed to develop septic arthritis (including arthritis due to atypical microorganisms such as mycoplasma), arthralgia and symmetrical (usually non-erosive) polyarthritis. In BA and CVID complicated by recurrent infections, amyloidosis, which may be itself a cause of arthropathy, can occur. In addition, patients with CVID and selective IgA deficiency show an increased prevalence of juvenile rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome and primary biliary cirrhosis, while patients with selective IgA deficiency are prone to developing seronegative spondylarthropathies, including ankylosing spondylitis. The mainstay of treatment for BA and CVID is replacement therapy with human immunoglobulins. Septic arthritis should be promptly treated with antibiotics, whereas other types of arthritis usually respond well to non-steroidal antiinflammatory medications. In contrast, the second line agents commonly used to treat rheumatoid arthritis do not appear to be beneficial in patients with PH-associated arthritis.
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Affiliation(s)
- N Pipitone
- Istituto di Reumatologia, Università, Siena
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Strengers PF. [Substitution therapy for deficiencies in antibody production by immunoglobulins]. Arch Pediatr 2000; 6 Suppl 2:423s-424s. [PMID: 10370557 DOI: 10.1016/s0929-693x(99)80489-8] [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] [Indexed: 11/17/2022]
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Affiliation(s)
- L Hammarström
- Division of Clinical Immunology, Huddinge University Hospital, Huddinge, Sweden.
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Rogers RL, Javed TA, Ross RE, Virella G, Stuart RK, Frei-Lahr D. Transfusion management of an IgA deficient patient with anti-IgA and incidental correction of IgA deficiency after allogeneic bone marrow transplantation. Am J Hematol 1998; 57:326-30. [PMID: 9544978 DOI: 10.1002/(sici)1096-8652(199804)57:4<326::aid-ajh10>3.0.co;2-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/11/2022]
Abstract
A patient with multiple myeloma was noted to have an IgA deficiency during investigation of a possible transfusion reaction due to IgA deficiency and anti-IgA. Because of the patient's age, otherwise good health, and early stage of disease, he was enrolled in a research treatment protocol that involved an allogeneic bone marrow transplant (BMT). The BMT successfully put the patient in complete remission from his multiple myeloma and corrected his IgA deficiency. Class-specific IgG anti-IgA antibody that had been identified prior to BMT was no longer detectable in his plasma. Anaphylactic transfusion reactions were successfully avoided by using a combination of IgA-deficient and washed blood components including the marrow graft, and IgA-reduced intravenous immunoglobulin.
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Affiliation(s)
- R L Rogers
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston 29425, USA
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Affiliation(s)
- A Hamvas
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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Guzzini F, Ceppi M, Gasparini P, Sali L, Vecchi C. [Primary thrombocythemia in a female carrier of IgA deficiency]. Recenti Prog Med 1996; 87:476-9. [PMID: 9026853] [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: 02/03/2023]
Abstract
We describe a case of essential thrombocythemia observed in a 67-year-old woman with severe IgA-deficiency. The the best of our knowledge, this is the first report concerning the onset of a chronic myeloproliferative disease (CMPD) in a patient affected with primary immunodeficiency, in particular IgA-defect. The association may be merely coincidental; otherwise hemopoietic growth factors acting on myeloid progenitor cells could play a role in this relationship. It has recently been shown that serum levels of many cytokines are elevated in patients with CMPD and probably contribute to enhance proliferation of the malignant clones; on the other hand interleukin-6 seems to account for reactive thrombocytosis, and significant amounts of circulating interleukin-4 and interleukin-6 have been detected in IgA-deficient patients. Overproduction of the two cytokines may depend on recurrent infections, but it could also represent a primary abnormality, with a putative role in the pathogenesis of the immune defect. These findings suggest that high levels of growth factors could induce myeloid hyperproliferation and so expose stem cells to genetic mutations responsible for malignant transformation.
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Affiliation(s)
- F Guzzini
- Divisione di Medicina II, Ospedale, USSL 4, Sarrono, Varese
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Gupta S, Aggarwal S, Heads C. Dysregulated immune system in children with autism: beneficial effects of intravenous immune globulin on autistic characteristics. J Autism Dev Disord 1996; 26:439-52. [PMID: 8863094 DOI: 10.1007/bf02172828] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S Gupta
- Division of Basic and Clinical Immunology, University of California, Irvine, USA
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Abstract
IgA deficiency is associated with high mortality (42% at 120 days) following liver transplantation (OLTx). Most of the mortality has been associated with enteric infections. Mother's milk, or human breast milk (HBM), is a rich source of IgA that is considered to have beneficial effects in terms of protection from microbial translocation and enteric infections. Two IgA-deficient OLTx recipients were given HBM orally for 10 days perioperatively. HBM was given in order to replenish intestinal IgA. Both patients had an excellent infection-free post-operative course. IgA levels in the serum rose from 5 to 10 mg/dl in one patient and from 7 to 30 mg/dl in the other. No complications from HBM administration were observed. We conclude that HBM can be used in IgA-deficient liver transplant recipients to reduce the risk of infectious complications in the post-operative period.
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Affiliation(s)
- H J Merhav
- Oklahoma Transplantation Institute, Baptist Medical Center, Oklahoma City 73112-4481, USA
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Sethi DS, Winkelstein JA, Lederman H, Loury MC. Immunologic Defects in Patients with Chronic Recurrent Sinusitis: Diagnosis and Management. Otolaryngol Head Neck Surg 1995; 112:242-7. [PMID: 7838546 DOI: 10.1016/s0194-59989570244-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/25/2022]
Abstract
Twenty patients with chronic refractory sinusitis or rhinitis were identified to have immune defects on the basis of total immunoglobulin level, immunoglobulin G subclass, and vaccine response. Eight patients were immunoglobulin A deficient, five had low immunoglobulin levels with vaccine hyporesponse, and four had low immunoglobulin levels with normal vaccine responses. Three subjects showed isolated immunoglobulin G1 deficiency. Demographic variables such as age, sex, infection pattern, and any other related disorders were studied retrospectively, which may have contributed to the diagnosis. An immunologic screen was essential for the diagnosis of immunodeficiency in these patients. Treatment options included prophylactic antibiotics, management of associated allergies, functional endoscopic sinus surgery, and replacement therapy with immunoglobulin in selected patients.
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Affiliation(s)
- D S Sethi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Pongrácz K, Varga L, Sáfrány B, Rajkai I. [Clinical aspects of IgA deficiency]. Orv Hetil 1994; 135:2863-6. [PMID: 7845656] [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: 01/27/2023]
Abstract
The authors have carried out a retrospective study of 33 selective IgA-deficient patients. They have found the high frequency of respiratory infections, gastrointestinal (celiac disease, giardiasis), and also autoimmune-, allergic- and malignant diseases. They have called the attention to the variety of the clinical picture, the possible consequences of the haemo- and immunotherapy, as well as to the importance of the early diagnosis and examination of family members.
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Affiliation(s)
- K Pongrácz
- Baranya Megyei Kerpel-Fronius Odön Gyermekkórház, Pécs
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Branco I, da Costa FB, Rodrigues A, Pires FR, Portugal MA, Gonçalves MD. [Gastric neoplasm associated with IgA deficiency. Importance of multidisciplinary care]. ACTA MEDICA PORT 1993; 6:587-92. [PMID: 8165929] [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: 01/29/2023]
Abstract
We present the case of 55-year old female patient with a rare malignant disease of the stomach associated with IgA deficiency. For its management the surgical, transfusional and renal support strategy required good coordination of pre, intra and post-operative care, and good articulation among the various sub-specialties. The patient experienced two severe anaphylactoid transfunctional reactions. Congenital IgA deficiency was detected with probable anti-IgA immunization associated with a metacrone adenocarcinoma of the stomach and nephrotic syndrome with renal failure. The transfusion methods utilized are discussed, and the results of the study aimed at detecting a compatible donor, with identical deficit, among family members are presented. In the absence of a national registry of donors with IgA deficiency, the prevention of these potentially dangerous reactions imposes a burden on the Service of Immuno-Hematherapy to take special measures on its own. This case points out the need to implement a blood bank with rare groups and IgA deficient blood, for homo/autologous transfusions.
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Affiliation(s)
- I Branco
- Serviço de Imuno-Hemoterapia, Hospital de Santa Maria, Lisboa
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Cunningham-Rundles C, Zhou Z, Mankarious S, Courter S. Long-term use of IgA-depleted intravenous immunoglobulin in immunodeficient subjects with anti-IgA antibodies. J Clin Immunol 1993; 13:272-8. [PMID: 8227286 DOI: 10.1007/bf00919386] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.2] [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: 01/29/2023]
Abstract
The use of intravenous immunoglobulin is standard practice for antibody replacement in the humoral immunodeficiency diseases. Most infusions proceed uneventfully, but a proportion of infusions (5-8%) produces some degree of an infusion reaction. While the cause of most of these infusion reactions is unknown, an established, but rare cause of reactions is IgA antibodies in the serum of the patient, which apparently forms an immune complex with the traces of IgA in the infused immunoglobulin. This article describes our studies of five immunodeficient patients who had high-titered anti-IgA antibodies and a history of severe infusion reactions to intravenous immunoglobulin products not depleted of IgA (IgA content, 270-720 micrograms/ml). Over a 6-year period we gave these patients IgA-depleted intravenous immunoglobulin for a total of 170 infusions. These infusions were generally well tolerated; however, mild to moderate infusion reactions did occur in 9 of the 170 infusions (5.3%). These reactions were not related to the IgA content of the immunoglobulin solutions used--ascertained to vary between 0.4 and 2.9 micrograms/ml of IgA. Levels of plasma C3a and C4a increased after immunoglobulin infusions but the appearance of these components was not accompanied by any infusion reaction. We conclude that the long-term infusions of IgA-depleted intravenous immunoglobulin, within the range of IgA concentrations investigated, into patients with even very high-titered antibodies to IgA, is a safe practice.
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Ventura A, Nassimbeni G, Martelossi S, Bohm P, D'Agaro PL. [Experience with gamma globulins per os in the therapy and prevention of infectious diarrhea]. Pediatr Med Chir 1993; 15:343-6. [PMID: 7505434] [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: 01/25/2023] Open
Abstract
The efficacy of oral gammaglobulin in the treatment of acute infectious diarrhea in immunocompetent children has been evaluated in an open placebo controlled trial. Moreover the efficacy of oral gammaglobulin has been tested also for treatment of chronic diarrhea in IgA deficient infants and for prevention of rotavirus infection during an epidemic in the ward. 54 infants (aged 1-36 months) with acute diarrhea (30 rotavirus +) were enrolled in the study. 24 out of 54 were assigned with randomised method to group a receiving gammaglobulin 150 mg/kg x 2 in the first day of admission to hospital and the remaining 30 infants were assigned to group b receiving placebo. Diarrhea cleared up in 2.57 +/- 1.4 days without a significant difference between group a and b (2.6 +/- 1.6 and 2.46 +/- 1.1 days respectively). The diarrhea's duration in Rotavirus+infants was 2.78 +/- 1.4 days in group a and 3 +/- 1.4 days in group b again without a significant difference. The excretion time of rotavirus in the stools was significantly shorter in rotavirus+group a (2.6 +/- 1.3) than in rotavirus group b (3.9 +/- 1.6) with p < 0.04. Three infants (4.9 months) with chronic post-infectious diarrhea and IgA deficiency (< 5 mg%ml) received gammaglobulin 300 mg/kg/die for 3 days. The diarrhea recovered in 2-3 days. Out of 16 infants hospitalized during an epidemic rotavirus diarrhea 6 infants received oral gammaglobulin at the dose of 150 mg/kg/die during the hospitalization period (that was at least 5 days). No one became ill.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Ventura
- Clinica Pediatrica, Istituto per l'Infanzia Burlo Garofolo di Trieste
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Gardulf A, Björvell H, Gustafson R, Hammarström L, Smith CI. Safety of rapid subcutaneous gammaglobulin infusions in patients with primary antibody deficiency. Immunodeficiency 1993; 4:81-84. [PMID: 7513227] [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: 05/21/2023]
Affiliation(s)
- A Gardulf
- Dept. of Clinical Immunology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
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Chiyoda S, Morikawa T. [Reinfusion of concentrated autogenous ascitic fluid in a patient with selective IgA deficiency]. Rinsho Ketsueki 1993; 34:39-43. [PMID: 8450606] [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: 01/30/2023]
Abstract
A 47 year-old man with selective IgA deficiency (SIgAD) consulted us in November 1981, with complaints of leg edema and common cold-like symptoms and was diagnosed as SIgAD based on data of his serum protein (IgG 2,160 mg/dl, IgM 65 mg/dl, no detectable IgA). Later in July 1989, he was admitted with edema and ascites. Laboratory examinations showed; total protein 4.6 g/dl, albumin 1.26 g/dl, IgG 2,375 mg/dl, IgM 38 mg/dl, no detectable IgA. C3 22 mg/dl, C4 6 mg/dl, antinuclear antibody 80X, anti dsDNA antibody 4.5 U/ml, anti IgA antibody 258%, and lymphocytopenia. Co-culture of lymphocytes from the patient and normal subject revealed deficiency of IgA synthesis in his B cell populations. Systemic lupus erythematosus was suggested based on the findings of skin biopsy, renal damage, oral ulcer, decreased complements, autoantibody and lymphocytopenia. We could not give him conventional products of albumin and frozen plasma because he had anti IgA antibody. Instead, we administered concentrated autogenous ascitic fluid and prednisolone. His ascitic fluid disappeared and complements and albumin in his serum normalized. He has continued in good condition and is being treated as an outpatient.
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Affiliation(s)
- S Chiyoda
- Department of Internal Medicine, Japanese Red Cross Nagasaki Atomic Bomb Hospital
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Hod M, Peled Y, Friedman S, Greenberg N, Blickstein D, Ovadia J. Selective IgA deficiency combined with immune thrombocytopenic purpura in pregnancy--problems in management. Br J Obstet Gynaecol 1992; 99:1016-7. [PMID: 1477006 DOI: 10.1111/j.1471-0528.1992.tb13710.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
MESH Headings
- Adult
- Female
- Humans
- IgA Deficiency/blood
- IgA Deficiency/complications
- IgA Deficiency/therapy
- Length of Stay
- Platelet Count
- Pregnancy
- Pregnancy Complications, Hematologic/blood
- Pregnancy Complications, Hematologic/immunology
- Pregnancy Complications, Hematologic/therapy
- Purpura, Thrombocytopenic, Idiopathic/blood
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/therapy
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Affiliation(s)
- M Hod
- Department of Obstetrics and Gynaecology, Beilinson Medical Centre, Petah Tiqa, Israel
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Abstract
Severe anaphylactic or allergic reactions may occur during blood transfusion to patients who are IgA-deficient and have anti-IgA in their blood, particularly those with class-specific antibodies. These patients are a particular challenge to the hospital transfusion service when large volumes of blood components are required for transfusion support, as in liver transplantation. We have successfully provided blood components for 3 such patients undergoing liver transplantation. Red cells were washed manually or by automated technique. Platelets were washed manually. All plasma was from IgA-deficient donors. One patient's entire plasma requirements were supplied by autologous plasmapheresis. Serial determinations of IgA levels and anti-IgA titers in 1 patient demonstrated an abrupt fall in anti-IgA with the appearance of barely detectable amounts of IgA during the surgery. IgA-containing plasma cells were demonstrated in the biopsies of liver homografts of 2 patients following transplantation. IgA deficiency with anti-IgA can be successfully managed during liver transplantation with advance planning.
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Olive D, Boilletot A, Neimann N. [Primary IgA deficiency (pure or in association). Report of 15 cases]. Ann Pediatr (Paris) 1977; 24:223-33. [PMID: 16211964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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