Clinical Features and Splenic Pathologic Changes in Patients With Autoimmune Hemolytic Anemia and Congenital Hemolytic Anemia

Chang, Chia-Wen; Li, Chin-Yang; Liang, Yeou-Hsiung; Stephen, S.

doi:10.1016/s0025-6196(12)60633-8

Cited by 13 publications

(7 citation statements)

References 9 publications

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“…On the other hands, only 4 cases were associated AIHA in a multicenter study of United States including 80 SMM cases [ 9 ]. Albeit not statistically significant in this study, females (73.3%) were predominant in the SMM group, consistent with the previous result (69.4%) [ 14 ]. To the best of our knowledge, this is the first series that describes the presence of SMM associated to wAIHA secondary to SLE, APLS, and Evans syndrome.…”

Section: Discussionsupporting

confidence: 90%

“…Overall, 15 patients (41.6%) showed the findings of SMM associated with wAIHA in our study. In few previous studies, the incidences of SMM in AIHA were highly variable (18–72%) [ 12 13 14 ]. In a retrospective study including 36 AIHA patients without lymphoproliferative disorder, 26 patients (72%) showed the finding of SMM [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…In few previous studies, the incidences of SMM in AIHA were highly variable (18–72%) [ 12 13 14 ]. In a retrospective study including 36 AIHA patients without lymphoproliferative disorder, 26 patients (72%) showed the finding of SMM [ 14 ]. However, the authors of the study neither assess the clinical implications of this phenomenon nor further specify the AIHA cases as wAIHA or cAIHA.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the treatment response, the SC group had a higher proportion of achieving CR to steroid than the SMM group ( P =0.04). This finding could be related to the chronic hemolysis in the SMM group, which could condition a poor response to the steroid regimen, as well as to a higher degree of disease, reflected by the larger hemosiderin deposits in the histological revision [ 12 14 ]. However, splenectomy and immunosuppressive agents did not show statistically significant difference in therapeutic response between both groups.…”

Section: Discussionmentioning

confidence: 99%

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Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

et al. 2018

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BackgroundSplenic myeloid metaplasia (SMM) is a kind of extramedullary hematopoiesis, whereas its clinical significance in wAIHA remains unclear. The aim of this study is evaluating the frequency and clinical characteristics of SMM, compared with splenic-congestion (SC).MethodsWe included patients with wAIHA treated in a Mexican tertiary hospital between January 1992 and December 2015. All patients received steroids as first-line treatment and splenectomy as second-line treatment.ResultsAmong the thirty-six splenectomized patients, 15 (41.6%) and 21 (58.4%) were diagnosed as SMM and SC, respectively. No differences were found in clinical characteristics between two groups. SMM patients showed lower platelet count (147×109/L vs. 240×109/L, P=0.02) and higher presence of anti-dsDNA antibodies (40% vs. 4.7%, P=0.01) than SC patients. Although the complete response (CR) rate with first-line treatment was lower in SMM patients (13.3% vs. 47.6%; P=0.04), post-splenectomy median disease-free-survival (DFS) was longer (16.2 mo vs. 5.1 mo; P=0.19). Univariate/multivariate analysis showed that achieving CR during first-line treatment (OR 0.3, 95% CI: 0.03–0.94, P=0.03) and higher platelet count (OR 0.99, 95% CI: 0.98–0.99, P=0.03) were protective factors for SMM; and anti-dsDNA titer higher than 9.6 IU/dL was a risk factor for SMM (OR 2.76, 95% CI: 1.48–5.14, P<0.001).ConclusionThe wAIHA patients with SMM have different biological profiles with those without SMM. This study is the first trial evaluating the significance of histopathological spleen findings and their association with rheumatologic profile.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

et al. 2018

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“…The major pathologic findings in autoimmune hemolytic anemia include increased polymorphonuclear neutrophil reaction, increased deposition of hemosiderin, and extramedullary hematopoiesis. In contrast, with the severity and the frequency of polymorphonuclear neutrophil reactions, deposition of hemosiderin, and extramedullary hematopoiesis were less in patients with congenital hemolytic anemia [25]. …”

Section: Hemosiderin As the Diagnosis Standard At Clinicsmentioning

confidence: 99%

Specific Hemosiderin Deposition in Spleen Induced by a Low Dose of Cisplatin: Altered Iron Metabolism and Its Implication as an Acute Hemosiderin Formation Model

Wang

et al. 2010

CDM

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Cisplatin is one of the commonly-used chemotherapeutic drugs to efficiently treat malignant tumors in clinic, however, the adverse effects of cisplatin such as nephrotoxicity, neurotoxcity, and hemolytic uremic syndrome are often observed at its clinical doses (~60 mg/m 2 ), which limit its broader application. In earlier studies, little attention was paid to the subtle changes in the architecture of lymphatic organs after low doses of cisplatin treatment. This paper reviews current understanding of cisplatin-induced erythrocyte injury, and presents our latest finding that a low dose of cisplatin (3.6 mg/m 2 /day, 14 days) could induce specific hemosiderin deposition in spleen of both normal and hepatoma-22 (H22) inoculated Balb/C mice. This dose of cisplatin significantly inhibited H22-induced acute ascites development. No significant toxicity was induced by this dose of cisplatin to tissues except for hemosiderin accumulation in the spleen of both normal and H22 tumor-bearing mice. Increased splenic iron content and erythrocyte injury were observed after treatment with the low dose of cisplatin. The mRNA levels of ferroportin (FPN1) and ferritin were upregulated by 25 and 5-fold in spleen, respectively. Overexpression of FPN1 and ferritin protein were also been observed at protein levels by Western blotting analysis. In addition, the mRNA expression of hepcidin was also increased, suggesting blockage of iron recycling through FPN1 in spleen with cisplatin treatment. In conclusion, cisplatin treatment damages the erythrocytes which accumulate in the red pulp of spleen with defective recycling of FPN1 and ferritin protein. Hepcidin inhibits the function of FPN1 as iron-exporter leading to iron overloaded inside ferritins of splenic cells, which are stained with abnormal hemosiderin accumulation. These results demonstrate that cisplatin-caused hemosiderin deposition in spleen provides a valuable clue for understanding the molecular basis of toxicity of cisplatin and hemosiderin accumulation and iron metabolism in vivo.

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Milz

Stutte¹

1999

Pathologie

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Clinical Features and Splenic Pathologic Changes in Patients With Autoimmune Hemolytic Anemia and Congenital Hemolytic Anemia

Cited by 13 publications

References 9 publications

Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

Specific Hemosiderin Deposition in Spleen Induced by a Low Dose of Cisplatin: Altered Iron Metabolism and Its Implication as an Acute Hemosiderin Formation Model

Milz

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