Adding insult to injury: autoimmune haemolytic anaemia complicated by pulmonary embolism

Woodson, Kevin Andrew; Lee, Yungah; Gopalratnam, Kavitha; Halene, Stephanie

doi:10.1136/bcr-2015-213575

Cited by 4 publications

(9 citation statements)

References 13 publications

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“…Very limited research exists investigating the association of anemia and pulmonary embolism, save for a single case report regarding autoimmune hemolytic anemia and subsequent PE shortly after AIHA diagnosis [16]. A fundamental distinction between the Can et al study and ours was the inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Anemia is not a risk factor for developing pulmonary embolism

Harringa

Bracken

Nagle

et al. 2017

The American Journal of Emergency Medicine

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Objective Our aim was to validate the previously published claim of a positive relationship between low blood hemoglobin level (anemia) and pulmonary embolism (PE). Methods This was a retrospective study of patients undergoing cross-sectional imaging to evaluate for PE at an academic medical center. Patients were identified using billing records for charges attributed to either magnetic resonance angiography or computed tomography angiography of the chest from 2008 to 2013. The main outcome measure was mean hemoglobin levels among those with and without PE. Our reference standard for PE status included index imaging results and a six-month clinical follow-up for the presence of interval venous thromboembolism, conducted via review of the electronic medical record. Secondarily, we performed a subgroup analysis of only those patients who were seen in the emergency department. Finally, we again compared mean hemoglobin levels when limiting our control population to an age and gender-matched cohort of the included cases. Results There were 1,294 potentially eligible patients identified, of whom 121 were excluded. Of the remaining 1,173 patients, 921 had hemoglobin levels analyzed within 24 hours of their index scan, and thus were included in the main analysis. Of those 921 patients, 107 (11.6%; 107/921) were positive for PE. We found no significant difference in mean hemoglobin level between those with and without PE, regardless of the control group used (12.4 ± 2.1 g/dL and 12.3 ± 2.0 g/dL [p = 0.85], respectively). Conclusions Our data demonstrated no relationship between anemia and pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Anemia is not a risk factor for developing pulmonary embolism

Harringa

Bracken

Nagle

et al. 2017

The American Journal of Emergency Medicine

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“…103–105 The influence of hemolysis on pulmonary vasoconstriction was evident in a case of autoimmune hemolytic anaemia, where PAP was significantly elevated despite only small clot burden, and iNO had impressive effect. 47 One case described how iNO closed a persistent foramen ovale in a patient with PE and multiple cerebral infarcts. 106…”

Section: Resultsmentioning

confidence: 99%

“…46 As NO causes pulmonary vasodilation, hemolysis can be an indirect cause of vasoconstriction. 47 Hemolysis-released adenosine di-phosphate and free Hb enhance platelet activation 48 which may cause further obstruction of the pulmonary vessels.…”

Section: Pulmonary Vasoconstriction In Acute Pementioning

confidence: 99%

“…[103][104][105] The influence of hemolysis on pulmonary vasoconstriction was evident in a case of autoimmune hemolytic anaemia, where PAP was significantly elevated despite only small clot burden, and iNO had impressive effect. 47 One case described how iNO closed a persistent foramen ovale in a patient with PE and multiple cerebral infarcts. 106 A number of case reports describe significant or even dramatic positive hemodynamic effects of iNO, and the effects seem to be present shortly after beginning of treatment 47,[93][94][95]99,[107][108][109] and at low doses.…”

Section: No-sgc-cgmp Pathwaymentioning

confidence: 99%

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Pulmonary vasodilation in acute pulmonary embolism – a systematic review

et al. 2020

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Acute pulmonary embolism is the third most common cause of cardiovascular death. Pulmonary embolism increases right ventricular afterload, which causes right ventricular failure, circulatory collapse and death. Most treatments focus on removal of the mechanical obstruction caused by the embolism, but pulmonary vasoconstriction is a significant contributor to the increased right ventricular afterload and is often left untreated. Pulmonary thromboembolism causes mechanical obstruction of the pulmonary vasculature coupled with a complex interaction between humoral factors from the activated platelets, endothelial effects, reflexes and hypoxia to cause pulmonary vasoconstriction that worsens right ventricular afterload. Vasoconstrictors include serotonin, thromboxane, prostaglandins and endothelins, counterbalanced by vasodilators such as nitric oxide and prostacyclins. Exogenous administration of pulmonary vasodilators in acute pulmonary embolism seems attractive but all come with a risk of systemic vasodilation or worsening of pulmonary ventilation-perfusion mismatch. In animal models of acute pulmonary embolism, modulators of the nitric oxide-cyclic guanosine monophosphate-protein kinase G pathway, endothelin pathway and prostaglandin pathway have been investigated. But only a small number of clinical case reports and prospective clinical trials exist. The aim of this review is to give an overview of the causes of pulmonary embolism-induced pulmonary vasoconstriction and of experimental and human investigations of pulmonary vasodilation in acute pulmonary embolism.

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“…However, the clinical features of PE attributed to AIHA are undermined. In 2015,Andrew Woodson [5] reported a 52year-old man presenting as progressive fatigue, weakness and palpitations was diagnosed with AIHA-PE.He experienced profound haemodynamic compromise while no large central emboli,only small pulmonary emboli in bilateral subsegmental arteries was observed on CTPA. Our case initially presenting with chest pain and syncope was considered as PE due to increased RV loading, broadened main pulmonary artery and invisible peripheral pulmonary vessels on CTPA.…”

Section: Discussionmentioning

confidence: 99%

Acute peripheral pulmonary embolism attributed to autoimmune haemolytic anaemia: a case report

Wang

Chen

2020

BMC Cardiovasc Disord

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Background: PE (pulmonary embolism) is a life-threatening complication rarely seen in the AIHA (autoimmune haemolytic anaemia) patients. Herein we reported a rare and serious AIHA-PE patient characterised by extensive peripheral pulmonary embolism on CTPA. Case presentation: A 59-year-old woman presented to our ED (emergency department) complaining of acute chest pain and dyspnea. During her presentation in ED she experienced a sudden syncope and soon developed CA (cardiac arrest). Laboratory studies showed a increase of CK-MB,troponin T,myoglobin and D-dimer. Computed tomography pulmonary angiography (CTPA) showed no large central or segment pulmonary emboli but increased RV (right ventricle)size,enlarged main pulmonary artery and invisible peripheral pulmonary artery. She was diagnosed with acute PE and alteplase was delivered intravenously. After thrombolytic therapy she remained hypotension and developed worsening anaemia. Detailed examination for anaemia revealed AIHA. She was discharged in a stable condition after 5 weeks with methylprednisolone and warfarin. Hb, D-dimer and transthoracic echocardiography showed complete recovery at 3-months follow up. Conclusion: PE attributed to AIHA is characterized by subsegment and distal pulmonary artery embolism which is easily neglected but always life-threatening. This case also highlights the PE as a secondary diagnosis should be evaluated comprehensively in order to identify the underlying pathogenesis.

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Adding insult to injury: autoimmune haemolytic anaemia complicated by pulmonary embolism

Cited by 4 publications

References 13 publications

Anemia is not a risk factor for developing pulmonary embolism

Anemia is not a risk factor for developing pulmonary embolism

Pulmonary vasodilation in acute pulmonary embolism – a systematic review

Acute peripheral pulmonary embolism attributed to autoimmune haemolytic anaemia: a case report

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