Immune Hemolysis: Diagnosis and Treatment Recommendations

Barcellini, Wilma

doi:10.1053/j.seminhematol.2015.05.001

Cited by 46 publications

(60 citation statements)

References 65 publications

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“…Diagnosis is primarily made by 2 criteria: symptoms of hemolysis and anemia, and positive direct antiglobulin test (DAT, Coombs test). [8,9] Response was defined as a rise in hemoglobin by at least 15 g/L and to a level of 100 g/L or greater. Other infections and hematological malignancies were ruled out by appropriate diagnostic procedures.…”

Section: Methodsmentioning

confidence: 99%

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

et al. 2016

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Autoimmune hemolytic anemia (AIHA) is a clinically relevant complication after allogeneic hematopoietic stem cell transplantation (HSCT). Currently, there is no established consensus regarding the optimal therapeutic approach. Whether AIHA contributes to increased mortality is still somewhat controversial.We investigated the incidence, risk factors, and outcome of post-transplant AIHA in 265 consecutive pediatric patients undergoing allo-HSCT over a 17-year period. Onset of AIHA was calculated from the first documented detection of AIHA by either clinical symptoms or positive direct agglutinin test. Resolution of AIHA was defined as normalization of hemoglobin and biochemical markers of hemolysis with sustained transfusion independence.We identified 15 cases of AIHA after allo-HSCT (incidence rate, 6%). Ten (67%) of these patients had a positive direct antiglobulin test. Data were obtained for 9 boys and 6 girls after a median follow-up of 53 months (range 4–102). The median age was 5.1 years (range 0.5–15.4) at the time of HSCT and the median time to emergence was 149 days (range 42–273). No significant risk factor for post-transplant AIHA has emerged from our data to date. In the majority (14 of 15; 93%) of AIHA patients, multiple agents for treatment were required, with 12 of 15 (80%) patients achieving complete resolution of AIHA. No splenectomy was performed in any of our patients.For various reasons, post-transplantation AIHA poses an extraordinary challenge to transplant physicians. Despite the advancements in diagnostic tools, therapeutic challenges remain due to the myriad interacting pathways in AIHA.

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Section: Methodsmentioning

confidence: 99%

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

et al. 2016

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“…In the presence of an acrosyndrome and when a hemolytic crisis is triggered by cold exposure, a cold antibody AIHA must be considered [1,3,5]. Such a clinical picture is much more common in cold antibody AIHAs.…”

Section: Clinical Picture Of Aihamentioning

confidence: 99%

“…The positive diagnosis of AIHA is based upon confirmation of hemolysis as well as detection of autoantibodies [1,[5][6][7].…”

Section: Positive Diagnosis Of Aihamentioning

confidence: 99%

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Autoimmune Hemolytic Anemia - A Short Review of the Literature, with a Focus on Elderly Patients

Mahdi²,

Mourot-Cottet³

et al. 2015

J Hematol Thrombo Dis

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Autoimmune hemolytic anemia (AIHA) is the most common extracorpuscular hemolytic anemia. AIHAs are related to the presence of autoantibodies directed against components of the erythrocyte membrane. To date, data related to AIHA are rare, primarily from retrospective studies of small effective. To our knowledge, data related to AIHA in elderly subjects are almost non-existent. Thus, we report our experience of 10 consecutive patients older than 75 years with a documented AIHA.

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“…AIHA is caused by autoantibodies against selfantigens in erythrocytes, leading to a premature RBC destruction, which could be diagnosed by a positive direct antiglobulin test (DAT) [3]. AIHA can be subdivided into warm, mixed, or cold-reactive subtypes, according to the optimal autoantibody-RBC reactivity Page 2 of 14 Chao et al Exp Hematol Oncol (2020) 9:6 temperatures [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of rituximab in autoimmune and microangiopathic hemolytic anemia: a systematic review and meta-analysis

Chao¹,

Chang

Yen³

et al. 2020

Exp Hematol Oncol

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Background: The efficacy and safety of rituximab (RTX) on hemolytic anemia (HA) is unknown. Therefore we retrospectively analyze the efficacy and safety of RTX in autoimmune hemolytic anemia (AIHA) and microangiopathic hemolytic anemia (MAHA) from the previous literature. Methods:Data in clinical trials and observational studies were collected from PubMed, Cochrane, Embase, and Google Scholar until Oct 15, 2018. The efficacy and safety of RTX in patients with AIHA or MAHA were assessed and overall response rates (ORRs), complete response rates (CRRs), adverse events (AEs) and relapse rates (RRs) were extracted if available. A meta-analysis was performed with a random-effects model, estimating mean proportions in all studies, and relative rates in comparative studies.Results: After quality assessment, a total of 37 investigations encompassing 1057 patients eligible for meta-analysis were included. Pooled mean proportion of ORR was 0.84 (95% confidence interval [CI] 0.80-0.88), and that of CRR was 0.61 (95% CI 0.49-0.73). Mean AE rate was 0.14 (95% CI 0.10-0.17), and mean RR was 0.21 (95% CI 0.15-0.26). Relative ORR was 1.18 (95% CI 1.02-1.36), and relative CRR was 1.17 (95% CI 0.98-1.39) fold more than the respective non-RTX counter parts. Relative AE rate was 0.77 (95% CI 0.36-1.63), and relative RR was 0.93 (95% CI 0.56-1.55) fold less than the respective non-RTX counter parts.Conclusion: RTX is more effective than the treatments without RTX for AIHA and MAHA and is well-tolerated. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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Immune Hemolysis: Diagnosis and Treatment Recommendations

Cited by 46 publications

References 65 publications

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

Risk factor analysis of autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation in children

Autoimmune Hemolytic Anemia - A Short Review of the Literature, with a Focus on Elderly Patients

Efficacy and safety of rituximab in autoimmune and microangiopathic hemolytic anemia: a systematic review and meta-analysis

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