It takes two to thrombosis: Hemolysis and complement

Delvasto-Núñez, Laura; Jongerius, Ilse

doi:10.1016/j.blre.2021.100834

Cited by 30 publications

(31 citation statements)

References 156 publications

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“…Finally, we found that one third of patients experiencing thrombosis had an associated disease, namely Evans' syndrome, paroxysmal nocturnal hemoglobinuria, and hemoglobinopathy. Although rare, these conditions should be considered because they may greatly increase thrombotic risk and be potentially fatal 26–30 …”

Section: Discussionmentioning

confidence: 99%

“…Although rare, these conditions should be considered because they may greatly increase thrombotic risk and be potentially fatal. [26][27][28][29][30] Our study carries several limitations, including the retrospective nature, the long span of observation, and the lack of systematic evaluation of thrombophilia screening. However, the prospective part Abbreviations: BMI, body mass index; VTE, venous thromboembolism.…”

Section: Complications and Outcomementioning

confidence: 99%

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Intravascular hemolysis and multitreatment predict thrombosis in patients with autoimmune hemolytic anemia

Fattizzo

Bortolotti

Giannotta

et al. 2022

Journal of Thrombosis and Haemostasis

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Background Thrombosis may complicate autoimmune hemolytic anemia (AIHA), but its predictors are still lacking, and no clear‐cut indications for anticoagulant prophylaxis are available. Objectives To characterize frequency and severity of thromboses in AIHA patients and identify risk factors for thrombosis that may advise primary anticoagulant prophylaxis. Patients/Methods A total of 287 consecutive AIHA patients diagnosed and followed from 1978 at a tertiary Italian center were retrospectively studied; 174 of them were prospectively evaluated from January 2020 until December 2021. AIHA relapse, thrombosis occurrence, and primary anticoagulant prophylaxis were evaluated. Results Thirty‐three AIHA patients (11.4%) experienced thrombosis, 70% of whom hospitalized. The cumulative thrombosis incidence was higher in patients with lactate dehydrogenase (LDH) ≥ 1.5 (hazard ratio [HR] 3.22), in those experiencing infections (HR 3.57), receiving transfusions (HR 3.06), rituximab (HR 3.3), or cyclophosphamide (HR 2.67). By multivariable analysis, LDH, transfusions, rituximab, and cyclophosphamide treatment emerged as independent factors associated with thrombosis. Among 174 patients prospectively followed in the past 2 years, we observed 70 acute hemolytic episodes in 45 patients; 33/45 displayed LDH ≥1.5 × upper limit of normal, and 17 received anticoagulant prophylaxis with low molecular weight heparin for a median of 70 days (30–300). In those receiving prophylaxis no thrombotic complications occurred, whereas five thrombotic episodes were registered in the remaining 16 cases. Conclusions Thrombosis was observed in about 11% of AIHA patients, mainly grade 3, and associated with intravascular hemolysis, need of transfusions, multitreatment, and infections, advising primary anticoagulant prophylaxis in these settings.

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Section: Discussionmentioning

confidence: 99%

Section: Complications and Outcomementioning

confidence: 99%

Intravascular hemolysis and multitreatment predict thrombosis in patients with autoimmune hemolytic anemia

Fattizzo

Bortolotti

Giannotta

et al. 2022

Journal of Thrombosis and Haemostasis

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“…Europeans with CAD demonstrated higher rates of venous thromboembolism [38,40], while in the Japanese patients the arterial TEs were particularly high [39]. The pathogenesis of hypercoagulability in AIHA involves activation of the compliment system and haemolysis (release of extracellular haemoglobin and heme) both of which promote activation of neutrophils, induce inflammation and vascular damage [41,42]. In CAD, complimentmediated haemolysis and thromboembolism risk persist year round [43].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Challenges in Orthogeriatric Patients with Cold Agglutinin Haemolytic Anaemia: Case Report and Management Algorithm

2022

Ann Case Report

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Most published reports on cold agglutinin (CA) haemolytic anaemia (CAHA), a rare condition with significant perioperative management challenges, are from patients who have undergone cardiothoracic surgery with hypothermia. Here, we report a hip fracture patient with CAHA, and review the perioperative management. This is the second published case report regarding CAHA in an orthopaedic patient. An 86 year old female with a 4-year history of recurrent episodes of CAHA and multiple comorbidities (atrial fibrillation, hypertension, strokes, secondary epilepsy, vascular dementia, and type 2 diabetes mellitus complicated by diabetic retinopathy, osteoporosis, urinary incontinence, recurrent urinary tract infections, and multinodular goitre) was admitted because of a hip fracture. She was commenced on prednisolone a month prior the hip fracture. On admission, her haemoglobin was 69 g/L, lactate dehydrogenase 494 U/L, haptoglobin <0.1 g/L and the blood film showed red blood cell agglutination at room temperature, which dissociated at 37 o C. She required transfusion of 5 units of packed red blood cells during her admission. Her management included intensive temperature monitoring, use of body thermal blanket, warming intravenous and irrigation fluids and medications before administration. Surgery was performed under general anesthesia on the 4th admission day. She received unfractionated heparin for venous thromboembolism prophylaxis, antibiotics for wound infection prophylaxis, continued prednisolone, and started anti-osteoporotic medications. The patient was discharged to another hospital for rehabilitation on the 7th postoperative day. Perioperative examination and treatment of orthogeriatric patients with CAHA is challenging. The pathophysiology of CAHA is shortly revied and a management algorithm is presented.

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“…Endothelial inflammation enhances leukocyte/ platelet adhesion by surface expression of adhesion molecules and release of prothrombotic von Willebrand factor and factor VIII. The role of hemolysis itself has come more into focus to contribute to procoagulant responses ( 58 ). The exposure of phosphatidylserine on the red blood cell (RBC) surface, the release of free hemoglobin and heme from damaged RBCs, and the shedding of RBC-derived microvesicles are well-established procoagulant factors ( 59 ).…”

Section: Prothrombotic Risks In Other Forms Of Anemiamentioning

confidence: 99%

Iron deficiency anemia and thrombosis risk in children—revisiting an old hypothesis

2022

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Iron deficiency anemia has a high prevalence in children and has repeatedly been implicated as a risk factor for arterial and venous thrombosis. As an effective therapy for iron deficiency anemia is available, understanding the association between this form of anemia and the potentially severe thrombosis phenotype is of major clinical interest. Recent findings shed light on pathophysiology of hypercoagulability resulting from iron-restricted erythropoiesis. Specifically, an animal model of induced iron deficiency allowed identifying multiple mechanisms, by which iron deficiency anemia results in increased thrombus formation and thrombus progression both in arterial and venous thrombosis. These findings complement and support conclusions derived from clinical data. The purpose of this mini review is to summarize current evidence on the association of iron deficiency anemia and thrombosis. We want to increase the awareness of iron deficiency as a risk factor for thrombosis in the pediatric population. We discuss how novel pathophysiological concepts can be translated into the clinical settings and suggest clinical studies on prevention and treatment strategies in high-risk patient groups.

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It takes two to thrombosis: Hemolysis and complement

Cited by 30 publications

References 156 publications

Intravascular hemolysis and multitreatment predict thrombosis in patients with autoimmune hemolytic anemia

Intravascular hemolysis and multitreatment predict thrombosis in patients with autoimmune hemolytic anemia

Perioperative Challenges in Orthogeriatric Patients with Cold Agglutinin Haemolytic Anaemia: Case Report and Management Algorithm

Iron deficiency anemia and thrombosis risk in children—revisiting an old hypothesis

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