Autoimmune hemolytic anemias and IgG antierythrocyte autoantibodies in Waldenström's macroglobulinemia: association with FcγRIIa polymorphism

Poulain, Stéphanie; Dervite, Isabelle; Leleu, Xavier; Fernandes, José; Stalnikiewicz, Laure; Moreau, Anne‐Sophie; Coiteux, Valérie; Botton, Stéphane de; Duthilleul, Patrick; Morel, Pierre

doi:10.1038/sj.leu.2404199

Cited by 7 publications

(9 citation statements)

References 9 publications

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“…When compared with autoimmune thrombocytopenia, AIHA has been reported more often, in approximately 5-16% of patients with LPL/WM [2][3]. In these patients, AIHA can be due to warm IgG antibodies, cold IgM antibodies or rarely from a combination of these [2][3][4][5][6][7][8][9]. Interestingly, in our patient, cold agglutinin and cryglobulin were negative although the patient had a history of Raynaud phenomenon.…”

Section: Discussionmentioning

confidence: 70%

“…Most patients with LPL/WM present with fatigue, weight loss or hyperviscosity. Autoimmune hemolytic anemia (AIHA) occurs in 5-16% of patients with LPL/WM, whereas autoimmune thrombocytopenia is rarely reported; and therefore, its precise incidence is not known [2][3][4][5][6][7][8][9][10][11][12]. There are no known reported patients with LPL/WM who had both AIHA and thrombocytopenia (Evans syndrome, ES).…”

Section: Introductionmentioning

confidence: 98%

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Amyloidosis, Evans syndrome and management options of lymphoplasmacytic lymphoma

Üstün

Savage

Manaloor

et al. 2009

Amyloid

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A 77-year-old man presented with Evans syndrome (ES), hard palate thickening, gastrointestinal (GI) hemorrhage, acute myocardial infarction (AMI) and pleural and pericardial effusions. The patient responded well to emergent ES treatment with high-dose steroids and intravenous immunoglobulin. Investigation revealed lymphoplasmacytic lymphoma (LPL) as well as amyloidosis in the hard palate, lymph nodes, and pericardium. Considering his age, non-myelosuppressive agents were administered, with the exception of dose-reduced cyclophosphamide. The patient developed neutropenic fever, atrial fibrillation and subsequently died. This report describes the first LPL patient with ES. LPL is generally an indolent disease. However, as in our patient, it can be life threatening because of its complications. ES contributed to his GI hemorrhage, severe anemia, and thus AMI at the time of presentation. Probable cardiac amyloidosis played a role in the latter phase (i.e. cardiac arrhythmia and hypotension during sepsis). Although rare, the presence of ES and amyloidosis should be investigated diligently in elderly LPL patients. Instead of aggressive myelosuppressive chemotherapy agents, targeted therapies might be considered in these fragile patients.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 98%

Amyloidosis, Evans syndrome and management options of lymphoplasmacytic lymphoma

Üstün

Savage

Manaloor

et al. 2009

Amyloid

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“…The results showed that the patient was FcγR α 131H/R and FcγR α 158F/V (Fig. 4), which indicated that the hemolysis may not have developed from the progression of WM 4 . Eltrombopag was highly suspected as the cause of hemolysis, since it was initiated 10 days before the onset of hemolysis, but no published evidence was available for its withdrawal regardless of its potential bene t in platelet recovery.…”

Section: Case Reportmentioning

confidence: 97%

First Report of Eltrombopag Induced Severe Autoimmune Hemolytic Anemia in the Management of Waldenström Macroglobulinemia-associated Autoimmune Thrombocytopenia

Shen

Ye³

et al. 2021

Preprint

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Background: Autoimmune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA) can be observed in Waldenström Macroglobulinemia (WM). The cause of AIHA should be carefully distinguished during the disease management. Case Presentation: A 63-year-old female WM patient complicated with thrombocytopenia, who was admitted to our department with a complaint of abdominal pain. After first half of bortezomib/dexamethasone/rituximab (BRD) chemotherapy, her platelet level recovered, but subsequently decreased to extremely low level (around 1-2×109/L), and the patient suffered from platelet transfusion refractoriness. During the management of refractory thrombocytopenia, the patient developed severe hemolytic anemia, and further tests confirmed warm AIHA. FcγRIIα polymorphism test showed that the patient had FcγRIIα-131RH, which implied that the AIHA may not be WM-related. Given the effects of ibrutinib in controlling WM, ibrutinib single treatment was started, which quickly corrected the thrombocytopenia within five days, but not hemolysis. With a relatively safe platelet level, eltrombopag was stopped, and the hemolysis alleviated within three days after eltrombopag withdrawal. Conclusion: This is the first report on eltrombopag-induced AIHA, and we should always keep in mind of the drug induced hemolysis even in disorders with autoimmune background.

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“…14 Although bone marrow infiltration via malignant lymphocytes and hepcidin overproduction leading to defective iron reuse are the most common etiologies of anemia in WM, autoimmune hemolytic anemia (AIHA) can also be encountered in the setting of this lymphoproliferative disorder. 15,16 AIHA is thought to be related to a cold-reactive IgM-mediated process. Cold agglutinins are antierythrocyte antibodies, usually type IgM, that bind to the I or i red blood cell antigens at temperatures less than 37 C. Patients with cold agglutinin disease present with hemoglobinemia and hemosiderinuria after cold exposure.…”

Section: Immune Cytopeniasmentioning

confidence: 99%

Autoimmune Manifestations in Patients With Waldenström Macroglobulinemia

Bockorny

Atienza

Dasanu

2014

Clinical Lymphoma Myeloma and Leukemia

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Autoimmune hemolytic anemias and IgG antierythrocyte autoantibodies in Waldenström's macroglobulinemia: association with FcγRIIa polymorphism

Cited by 7 publications

References 9 publications

Amyloidosis, Evans syndrome and management options of lymphoplasmacytic lymphoma

Amyloidosis, Evans syndrome and management options of lymphoplasmacytic lymphoma

First Report of Eltrombopag Induced Severe Autoimmune Hemolytic Anemia in the Management of Waldenström Macroglobulinemia-associated Autoimmune Thrombocytopenia

Autoimmune Manifestations in Patients With Waldenström Macroglobulinemia

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