Life-Threatening Autoimmune Hemolytic Anemia Treated with Manual Whole Blood Exchange with Rapid Clinical Improvement

Cooling, Laura; Boxer, Grace Jordison; R, Simon

doi:10.4172/2155-9864.1000163

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…This corresponds with successes that physicians had previously experienced with TPE, as reported by a number of case reviews. [17][18][19][20][21][22][23][24] Based on our results, the use of TPE may result in increased adverse event incidence. However, the increase was not significant, the NNH was large, and it is likely that some adverse events (such as allergic reactions to blood transfusions reported by 2019 Yang and 2019 Jiang) could be attributed to concurrent therapies instead of TPE.…”

Section: Previous Studies and Clinical Implicationsmentioning

confidence: 61%

“…15 The use of TPE in AIHA has long been theorized to be effective as it can potentially remove hemolytic autoantibodies and activated complements proteins from circulation, thereby reducing the severity of the hemolytic reactions. 16 Despite promising theories, previous case studies and observations have yielded conflicting results, with some claiming that TPE is able to significantly improve laboratory parameters and clinical symptoms, [17][18][19][20][21][22][23][24] some claiming that it is not effective in treating AIHA, 25 while others suggesting that TPE is only effective for cold AIHA. 26 Based on these evidences, the American Society for Apheresis (ASFA)'s latest guidelines published in 2019 designated the use of TPE in severe cold AIHA as a category II indication, suggesting that TPE is applicable as a second-line therapy, either as a standalone treatment or in conjunction with other modes of treatment.…”

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: Previous Studies and Clinical Implicationsmentioning

confidence: 61%

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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Efficacy of Whole-Blood Exchange Transfusion in Refractory Severe Autoimmune Haemolytic Anaemia Secondary to Systemic Lupus Erythematosus: A Real-World Observational Retrospective Study

et al. 2022

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BackgroundSevere autoimmune haemolytic anaemia (AIHA) in systemic lupus erythematosus (SLE) patients could be life-threatening and formidable, especially in those nonresponsive to glucocorticoids (GCs) and immunosuppressants (ISAs). Whole-blood exchange transfusion (WBE), with plasma exchange and pathogenic cell removal as well as healthy red blood cell transfusion, could be beneficial. The objective of this study was to investigate the efficacy and safety of WBE in combination with GCs/ISAs.MethodsIn this retrospective study, the clinical data of 22 refractory severe SLE-AIHA inpatients between February 2016 and February 2021 were collected and analysed, among whom 14 patients had received WBE and were compared with those treated with typical second-line therapy of intravenous immunoglobulin and/or rituximab (IVIG/RTX).ResultsAmong the 22 severe refractory SLE-AIHA patients, eight patients received IVIG and/or RTX without WBE (group 1, IVIG/RTX, n = 8), seven patients were given WBE without IVIG/RTX (group 2, WBE alone, n = 7), and seven patients who failed initial IVIG/RTX therapy were given sequential WBE therapy (group 3 IVIG/RTX→WBE, n = 7). Fourteen patients had accepted WBE treatment regardless of prior IVIG/RTX usage (group 2 + 3, WBE ± IVIG/RTX, n = 14). On days 1, 3, 5, and 7 after corresponding therapies, patients of groups 2, 3, and 2 + 3 showed significantly higher levels of haemoglobin (Hb) than patients of group 1. Compared with patients of group 1, patients of groups 2, 3, and 2 + 3 took less time to reach and maintain Hb ≥60 g/L from baseline. Groups 2 and 2 + 3 consumed a lower dose of GCs than group 1 to reach and maintain Hb ≥60 g/L from baseline. Group 1 experienced longer hospital stays than group 2, and group 3’s cost of hospitalisation is more than groups 1 and 2. Hbmin <40 g/L may be a key indicative factor for initiating WBE remedy therapy as IVIG/RTX may not be effective enough in 48–72 h in those patients with refractory severe SLE-AIHA. No severe adverse effects were observed in the WBE group.ConclusionsWBE could be a safe and beneficial alternative therapy for refractory severe SLE-AIHA.

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Life-Threatening Autoimmune Hemolytic Anemia Treated with Manual Whole Blood Exchange with Rapid Clinical Improvement

Cited by 2 publications

References 33 publications

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

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

Efficacy of Whole-Blood Exchange Transfusion in Refractory Severe Autoimmune Haemolytic Anaemia Secondary to Systemic Lupus Erythematosus: A Real-World Observational Retrospective Study

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