Current treatment options for severe autoimmune hemolytic anemia

Yeşilbaş, Osman

doi:10.5152/turkpediatriars.2018.6499

Cited by 3 publications

(3 citation statements)

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“…Currently, corticosteroids are used as first‐line treatments against AIHA with rituximab serving as a second‐line therapy along with splenectomies 7,9,10 . Additional therapies, including intravenous immunoglobulins, high‐dose steroids, and therapeutic plasma exchange (TPE) are only recommended for patients with an acute onset of AIHA 7,9,11 . However, due to the rarity of AIHA, there is a lack of randomized controlled trials (RCTs) investigating the efficacy and safety of the aforementioned regimens in English literature sources 7,12,13 .…”

Section: Introductionmentioning

confidence: 99%

“…7,9,10 Additional therapies, including intravenous immunoglobulins, highdose steroids, and therapeutic plasma exchange (TPE) are only recommended for patients with an acute onset of AIHA. 7,9,11 However, due to the rarity of AIHA, there is a lack of randomized controlled trials (RCTs) investigating the efficacy and safety of the aforementioned regimens in English literature sources. 7,12,13 To date, there is no evidence-based treatment strategy for AIHA; clinical management of AIHA is largely dependent upon physician experience and patient characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of therapeutic plasma exchange for treatment of autoimmune hemolytic anemia: A systematic review and meta‐analysis of randomized controlled trials

Deng

Zhou

Wong

et al. 2020

J of Clinical Apheresis

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Objective We performed a systematic review and meta‐analysis to evaluate the efficacy and safety of therapeutic plasma exchange (TPE) in adult patients with autoimmune hemolytic anemia (AIHA). Methods A search of major English and Chinese databases for randomized controlled trials (RCTs) comparing the use of TPE against no TPE in adult AIHA patients was performed. Outcomes were remission incidence, hematological parameters (ie, hemoglobin count, red blood cell count, reticulocyte percentage, total bilirubin, and hematocrit) and adverse event incidence. Results Thirteen RCTs containing 906 patients were included. A majority of RCTs were given an unclear risk of bias. TPE was associated with increased remission incidence (risk ratio [RR] = 1.22, 95% confidence interval [CI] = 1.15‐1.30) and improved hematological parameters. TPE was also associated with an insignificant increase in adverse event incidence (RR = 1.12, 95% CI = 0.68 to 1.86). Publication bias was detected for remission incidence and reticulocyte percentage, and it may have led to an overestimation of beneficial improvements in reticulocyte percentage. Conclusion TPE was associated with both increased remission incidence and improved hematological parameters. It is capable of improving short‐term hematological parameters to stabilize acute AIHA onset. Our results should be interpreted with caution due to the unclear risk of bias and the presence of publication biases. We were not able to determine the treatment effects for cold and warm AIHA separately due to a lack of subgroup data. Future RCTs incorporating larger sample sizes with subgroup data for warm and cold AIHA are needed to validate our findings and establish subgroup efficacy and safety.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of therapeutic plasma exchange for treatment of autoimmune hemolytic anemia: A systematic review and meta‐analysis of randomized controlled trials

Deng

Zhou

Wong

et al. 2020

J of Clinical Apheresis

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“…Metade desses pacientes pode responder ao rituximabe, embora as respostas geralmente durem pouco. 20 A explicação para esses fatos se sustenta no fato de que é observada uma alta taxa de falta de resposta aos esteróides e a hemólise ocorre por via intravascular e no fígado e não no baço. 21 Nesse contexto, notou-se uma decisão acertada pela equipe médica que conduziu o caso, uma vez que fez uso correto de tratamentos de primeira linha na medida em que obteve-se boa resposta.…”

Section: Discussionunclassified

Anemia hemolítica autoimune idiopática com dissidência clínico-laboratorial

Da Silva,

Albuquerque,

Monteiro

et al. 2023

Braz. J. Hea. Rev.

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A anemia hemolítica autoimune (AIHA) é uma doença incomum, em que ocorre a destruição de hemácias mediada por autoanticorpos do hospedeiro, sendo sua patogênese ainda pouco esclarecida. O presente estudo descreve um caso de uma mulher de 45 anos com anemia hemolítica autoimune idiopática com clínica sugestiva de mediação por anticorpos quentes (w-AIHA) e laboratório confirmatório de doença de aglutinina fria (DAC). Observou-se uma história clínica comum às anemias hemolíticas, com predomínio de sintomas sistêmicos como astenia, perda de peso, dispneia e febre diária, provas inflamatórias elevadas sem evidência de infecções ou doença reumatológica em curso. As provas laboratoriais evidenciaram DAC, entretanto, a idade da paciente, a característica dos sintomas sistêmicos e a ausência de sintomas de aglutinação dependente do frio tornavam o quadro semelhante a w-AIHA. Observou-se uma apresentação de AHAI idiopática com discrepância entre manifestações clínicas e laboratoriais. A terapia teve boa resposta à corticoides e imunossupressores, considerada uma terapia de primeira linha para w-AIHA sem o uso de imunobiológicos, optando-se por terapia de imunossupressão alternativa.

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