Clinical relevance of silent red blood cell autoantibodies

Mauro, Francesca Romana; Trastulli, Fabio; Alessandri, Cristiano; Valesini, Guido; Giovannetti, Gianluca; Riemma, Costantino; Porrazzo, Marika; Pepe, Sara; Colafigli, Gioia; Caputo, Maria; Propris, M. S. De; Guarini, Anna; Girelli, Gabriella; Coluzzi, Serelina; Foà, Robin

doi:10.3324/haematol.2017.177675

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…‘Silent’ CA can be serologically detectable in healthy blood donors, in pregnant females and in patients with autoimmune disorders,25 as well as in adults without evidence of haemolysis or disease and in other patients having non-related disorders. These ‘normal’ CA are present in titres generally below 64 and have low thermal amplitudes which is insufficient for any biological activity in vivo 26.…”

Section: Discussionmentioning

confidence: 99%

Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination

Gioia¹,

Fumi

Fiorini

et al. 2018

J Clin Pathol

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AimsThe presence of cold agglutinin in blood samples can cause a spontaneous agglutination of red blood cells (RBCs) when low temperature occurs. This phenomenon causes a spurious lowering of RBC count on the automated haematological analysers that are detected by incongruous values (≥370 g/L) of the mean cellular haemoglobi concentration (MCHC). A preheating at 37°C can remove the RBC agglutination generally resulting in a reliable count. It has been reported that the same result can be reached by using the optical reticulocyte (RET) channel of Sysmex analysers where the RBC count is not influenced by the presence of cold agglutinin. This study aims to evaluate these data in a larger population, with regard to environmental conditions on Sysmex analysers. We have also evaluated the influence of different thermal pretreatments on the RBC count.MethodsThis study was performed on 96 remnants of peripheral blood samples (48 with MCHC in normal range and 48 with MCHC>370 g/L) which have been analysed in different preanalytical conditions on the Sysmex analysers.ResultsA preheating of samples at 41°C for 1 min leads to a reversibility of the cold agglutination comparable to the one observed in the RET channel and yields better results compared with 37°C for 2 hours.ConclusionsNone of described procedures assure the complete cold agglutination reversibility in every case. Consequently, since the haematological analysers not yet provide reliable parameters to confirm the complete resolution of agglutination, further verification of RBC count accuracy needs to be performed.

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Section: Discussionmentioning

confidence: 99%

Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination

Gioia¹,

Fumi

Fiorini

et al. 2018

J Clin Pathol

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“…In a minority of healthy people, blood tests will detect CA that have no clinical significance (Bendix et al , ; Mauro et al , ). A frequency of positive screening tests at 0·3% was reported in a large cohort of patients with nonrelated disorders, but only 43% of these had demonstrable CA by titration (Jain et al , ).…”

Section: Diagnosis and Clinical Featuresmentioning

confidence: 99%

“…A risk of thromboembolic complications has been well documented for AIHA in general but has been more difficult to show for CAD in particular (Barcellini et al , ). Some studies of (probably) selected patients did report an increased frequency of such events in CAD (Röth et al , ; Mullins et al , ). A recent, large, registry‐based study of individuals with the term CAD repeatedly mentioned in their medical records found a relative frequency of between 1·5 and 2·0 as compared to age‐matched controls (Broome et al , ).…”

Section: Diagnosis and Clinical Featuresmentioning

confidence: 99%

“…CAD is an uncommon disease that mainly affects elderly or middle‐aged people (Berentsen et al , ; Swiecicki et al , ; Barcellini et al , ; Mullins et al , ). A descriptive, population‐based study in Norway found a prevalence of 16 per million inhabitants and an incidence rate of 1 per million inhabitants per year, which is probably an underestimation (Berentsen et al , ).…”

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How I manage patients with cold agglutinin disease

Berentsen

2018

Br J Haematol

111

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Cold agglutinin disease (CAD) is an uncommon autoimmune haemolytic anaemia in which a well-defined, clonal low-grade lymphoproliferative disorder of the bone marrow results in erythrocyte destruction mediated by the classical complement pathway. The pathogenesis, clinical features and diagnostic criteria are reviewed. Although anaemia is mild in some patients, approximately one-third of untreated patients have a haemoglobin level of ≤80 g/l, and about 50% have been considered transfusion dependent for shorter or longer periods. Therapy has improved greatly during the last 15 years. Mild disease can be managed by avoidance of cold and adequate precautions in specific situations, without drug therapy. Corticosteroids should not be used to treat CAD. Patients requiring pharmacological therapy should be considered for prospective trials. Outside clinical studies, the rituximab-bendamustine combination or rituximab monotherapy is recommended in the first line, depending on individual patient characteristics. Second-line options are rituximab-fludarabine in fit patients or, although less strongly documented, a bortezomib-based regimen. Therapies targeting the classical complement pathway are promising, and the complement C1s inhibitor, BIVV009, has shown favourable results in preliminary studies.

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“…Remarkably, thus far only a single, partial-sample study of one diabetes autoantibody in adults was performed in NHANES; and no diabetes autoantibody data have been collected for the adolescent and pediatric population. Further, some proportion of individuals who are positive for red cell autoantibodies have related diagnosable disorders [89]. Thus far in NHANES, the two major pernicious anemia-autoimmune atrophic gastritis-related autoantibodies (anti-intrinsic factor autoantibody and anti-parietal cell autoantibodies) have not been studied.…”

Section: Autoantibodies Disease Associationsmentioning

confidence: 99%

Population-based estimates of humoral autoimmunity from the U.S. National Health and Nutrition Examination Surveys, 1960–2014

2020

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ObjectiveBased on US National Health and Nutrition Examination Survey (NHANES) data, we attempted to provide an unbiased, population-based estimate of autoantibody prevalence overall and by age and sex. MethodsUS autoantibody prevalence estimates for detectable rheumatoid factor, anti-thyroglobulin, anti-thyroperoxidase, anti-transglutaminase, anti-endomysial, anti-GAD65, antinuclear autoantibodies, and autoantibodies to extractable nuclear antigens were estimated from the 1960-1962 National Health Examination Survey, NHANES III (1988, and the NHANES 1999-2014 cross-sectional surveys. Survey design variables and sample weights were used to account for differential probabilities of selection within the complex survey design. Data analysis used SAS TM and SUDAAN™ software. US Census Bureau data were used to estimate the absolute numbers of persons with autoantibodies.

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Clinical relevance of silent red blood cell autoantibodies

Cited by 9 publications

References 15 publications

Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination

Short preheating at 41°C leads to a red blood cells count comparable to that in RET channel of Sysmex analysers in samples showing cold agglutination

How I manage patients with cold agglutinin disease

Population-based estimates of humoral autoimmunity from the U.S. National Health and Nutrition Examination Surveys, 1960–2014

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