Autoimmune Hemolytic Anemia with Reticulocytopenia and Erythroid Marrow

Conley, C. Lockard; Lippman, Scott M.; Ness, Paul M.; Petz, Lawrence D.; Branch, D. R.; Gallagher, Michael T.

doi:10.1056/nejm198202043060507

Cited by 85 publications

(37 citation statements)

References 18 publications

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“…Assuming little normocyte production during this period, the normocyte Bone marrow aspirate findings on day 14 in horse 1 and day 2 in horse 2 were consistent with the increasing packed cell volume, mean corpuscular volume, and erythrogram findings. The erythroid bone marrow cytology in horse 1 on day 2 indicated that there may have been immune-mediated destruction of late stage precursors as observed in man [6]. The initial mildly increased mean corpuscular volume and relatively wide erythrogram in this horse suggests that effective erythropoiesis had occurred earlier in the disease.…”

Section: Resultsmentioning

confidence: 64%

Erythrocyte Volume Distribution Analysis and Hematologic Changes in Two Horses with Immune-mediated Hemolytic Anemia

Weiser

Kohn

1983

Vet Pathol

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Abstract. Immune-,mediated hemolytic anemia was diagnosed in two horses on the basis of regenerative anemia, increased erythrocyte fragility in hypotonic saline, autoagglutination, and a positive direct antiglobulin (Coomb's) test. During steroid therapy partial resolution of the anemia was indicated by rising packed cell volume, macrocytosis, and bone marrow erythroid hyperplasia. Using erythrocyte volume distribution histograms (erythrograms), the regenerative response was characterized by analysis of macrocytic and normocytic erythrocyte subpopulations. In both horses, a gradual net increase of about 2 X lo6 macrocytes/pl occurred over a four-to five-week period. Over the same interval there was a gradual decrease in the number of normocytes. We suggest that the macrocytes remained large through this period rather than contributing to normocyte population growth. Erythrograms may provide an additional means of evaluating erythrocyte regeneration in horses.Immune-mediated hemolytic anemia is an uncommon disorder in horses. Several descriptions of clinical cases have been reported [ 1,5,7,9,10, 181. Assessment of erythrocyte regeneration in horses is relatively difficult since reticulocyte maturation is confined to the bone marrow. Using serial hemograms, a rising packed cell volume over a period of days or weeks can document a regenerative response in retrospect. In marked regenerative responses, the mean corpuscular volume may increase above the normal range [ 14, 161. An increased mean corpuscular volume was interpreted as evidence of regeneration in several horses with immune-mediated hemolytic anemia [5]. Examination of bone marrow aspirate films for the degree of polychromasia and myeloid to erythroid ratio provides an additional means of assessing regeneration [ 13, 141. Three horses with immune-mediated hemolytic anemia were considered to have regenerative anemia based on marrow findings [ 1, 9, 181. Recently it was shown that horses have increased erythrocyte concentrations of creatine, glucose-6-phosphate dehydrogenase [ 161, and adenosine triphosphate [ 171 in association with experimentally induced regenerative anemia.Erythrograms may provide yet another means of assessing and even quantitating the regenerative response in horses. Erythrograms are more sensitive than mean corpuscular volume values in detecting disturbances of erythrocyte size [2, 3, 111. 424

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Section: Resultsmentioning

confidence: 64%

Erythrocyte Volume Distribution Analysis and Hematologic Changes in Two Horses with Immune-mediated Hemolytic Anemia

Weiser

Kohn

1983

Vet Pathol

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“…Both autologous and allogeneic monocyte-macro phages were isolated from heparinized whole blood by density gradient centrifugation and assayed for activity against antibody-coated positive control red cells, un sensitized negative control red cells and against red cells of patients using an assay system previously described [12][13][14], Briefly, mononuclear cells, either from the patient or from normal volunteers, were isolated within 24 h of collection by density gradient centrifugation using Ficoll-Paque (Pharmacia, Piscataway, N.J.). After washing, the mononuclear cells were diluted to a concentration of 106 cells/ml in RPMI-1640 culture medium (Flow Laboratories, Inglewood, Calif.), sup plemented with 10% fetal calf serum (Flow Laborato ries).…”

Section: Monocyte-macrophage Interaction With Erythrocytesmentioning

confidence: 99%

Reticuloendothelial Cell Function in a-Methyldopa-Induced Hemolytic Anemia

Branch¹,

Gallagher²,

Shulman³

et al. 1983

Vox Sanguinis

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2 patients having a-methyldopa-induced hemolytic anemia were followed sequentially using an in vitro assay of autologous monocyte-macrophage activity to determine if their reticuloendothelial system (RES) function was abnormal and thus could be related to the mechanism of lysis. RES function was evaluated while the patients were actively hemolyzing and during remission, following discontinuance of the drug. The results indicated that RES activity is normal in patients having hemolytic anemia due to amethyldopa administration. Also, following cessation of drug therapy, the patients’ IgGcoated red cells interacted significantly for a prolonged period (4-5 months) with autologous or normal allogeneic monocyte-macrophages. This was associated with a concurrent reticulocytosis and indicates a persistent low-level hemolytic phase throughout this period, even though hemoglobin and hematocrit values remained within the normal ranges. Although levels of IgG sensitizing the patients’ red cells were essentially constant during the hemolytic phase and when the patients were in complete remission, significant monocytemacrophage activity was only evident during the hemolytic period. In an attempt to explain this phenomenon, it is postulated that hemolysis in patients receiving a-methyldopa is related to the interaction of drug with red cell membrane proteins which results in a variably expressed ‘altered’ antigen which is recognized by ‘autoantibody’. The proper expression of the Fc portion of the immunoglobin molecule to result in specific recognition by receptors on monocyte-macrophages depends upon the extent of the antigen alteration by a-methyldopa. If the drug does not result in appropriate antigen alteration, then, although ‘autoantibody’ may still bind to the red blood cell, its Fc region is not readily recognized by monocyte-macrophages and little or no erythrophagocytosis occurs.

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“…However, reticulocytopenia may occur in only a number of cases and may result in a life-threatening situation with a lack of compensatory mechanisms [1,2].…”

Section: Introductionmentioning

confidence: 99%

Erythropoietin May Improve Anemia in Patients with Autoimmune Hemolytic Anemia Associated with Reticulocytopenia

Arbach

Funck

Seibt³

et al. 2012

Transfus Med Hemother

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Background: Management of patients with autoimmune hemolytic anemia (AIHA) and reticulocytopenia remains challenging. Case Reports: Two patients with decompensated AIHA who were receiving immunosuppressive drugs were treated with erythropoietin (EPO). Administration of EPO increased reticulocyte counts and hemoglobin concentrations in both cases. One patient completely recovered following a short course of treatment. Hemolysis could be compensated in the second patient using only mild doses of immunosuppressive drugs in combination with EPO. Conclusion: The administration of EPO should be considered in patients with therapyrefractory AIHA, particularly in the presence of reticulocytopenia.

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Autoimmune Hemolytic Anemia with Reticulocytopenia and Erythroid Marrow

Cited by 85 publications

References 18 publications

Erythrocyte Volume Distribution Analysis and Hematologic Changes in Two Horses with Immune-mediated Hemolytic Anemia

Erythrocyte Volume Distribution Analysis and Hematologic Changes in Two Horses with Immune-mediated Hemolytic Anemia

Reticuloendothelial Cell Function in a-Methyldopa-Induced Hemolytic Anemia

Erythropoietin May Improve Anemia in Patients with Autoimmune Hemolytic Anemia Associated with Reticulocytopenia

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