Rituximab use in Warm and Cold Autoimmune Hemolytic Anemia

Murakhovskaya, Irina

doi:10.20944/preprints202011.0576.v1

Cited by 4 publications

(2 citation statements)

References 108 publications

(154 reference statements)

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“…Recently, new groups of drugs that inhibit immune responses at various levels have been developed. In most patients with CAD requiring treatment, B cell-directed approaches such as monotherapy with rituximab (an anti-CD20 antibody which depletes B cells) or combined with purine nucleoside analogues (e.g., bendamustine, fludarabine) are currently recommended as the first choice [18,[61][62][63][64]. Prophylactically used eculizumab (anticomplement C5 monoclonal antibody) prevented exacerbation of haemolysis in a patient with chronic CAD who underwent aortic valve replacement with full cardiopulmonary bypass at normothermia [34].…”

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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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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“…Rituximab was approved for treating RA in combination with methotrexate, which could improve symptoms in patients [45]. Also, promising results have been shown in treating other autoimmune diseases including systemic lupus erythematosus [46], dermatomyositis [47], severe autoimmune hemolytic anemia [48,49], refractory immune thrombocytopenic purpura [50], Wegener's granulomatosis [51]. Ocrelizumab (Ocrevus®) is another humanized anti-CD20 antibody that targets CD20 molecules on B lymphocytes.…”

Section: Anti-cd20 Monoclonal Antibodiesmentioning

confidence: 99%

Introduction on Monoclonal Antibodies

Sadeghalvad¹,

Rezaei²

2021

Monoclonal Antibodies

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Monoclonal antibodies (mAbs) are a group of antibodies produced by identical clones of B lymphocytes against a particular antigen. mAbs are identical in several properties such as protein sequence, antigen-binding site region, binding affinity for their targets, and identical downstream functional effects. These characteristics of mAbs highlight their differences with the polyclonal antibodies which have heterogenous activities and recognize different epitopes on an antigen. Murine mAbs was the first generation of mAbs developed by hybridoma technology however, because of their murine origin, they can trigger the anti-mouse antibody response in the host which could accelerate mAb clearance and undesirable allergic reactions upon repeated administration. This issue was resolved by developing engineering methods toward producing less immunologic chimeric or humanized antibodies. mAbs applications have become a novel way of targeting antigens in a wide variety of diseases such as autoimmunity, malignancies, and asthma. In addition, high specificity and high affinity binding properties of mAbs make them effective biological reagents in immunodiagnostic assays. They can be used in diagnosis of infectious diseases and detection of certain antigens or in serological assessments for detection of antibodies against a certain antigen. This chapter summarizes the general properties of mAbs, their production processes, and their important diagnostic and therapeutic applications.

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Anti-B-Cell-Activating Factor (BAFF) Therapy: A Novel Addition to Autoimmune Disease Management and Potential for Immunomodulatory Therapy in Warm Autoimmune Hemolytic Anemia

Cheekati,

Murakhovskaya

2024

Biomedicines

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Although rituximab is not specifically approved for the treatment of warm autoimmune hemolytic anemia (WAIHA), the First International Consensus Group recommends considering its use as part of the initial therapy for patients with severe disease and as a second-line therapy for primary WAIHA. Some patients do not respond to rituximab, and relapses are common. These relapses are associated with elevated B-cell-activating factor (BAFF) levels and the presence of quiescent long-lived plasma cells (LLPCs) in the spleen. A new group of immunomodulatory drugs, B-cell-activating factor inhibitors (BAFF-i), demonstrated efficacy in multiple autoimmune diseases and have the potential to improve WAIHA treatment outcomes by targeting B-cells and LLPCs. This article reviews the role of BAFF in autoimmune disorders and the currently available literature on the use of BAFF-directed therapies in various immunologic disorders, including WAIHA. Collectively, the clinical data thus far shows robust potential for targeting BAFF in WAIHA therapy.

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Rituximab use in Warm and Cold Autoimmune Hemolytic Anemia

Cited by 4 publications

References 108 publications

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

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

Introduction on Monoclonal Antibodies

Anti-B-Cell-Activating Factor (BAFF) Therapy: A Novel Addition to Autoimmune Disease Management and Potential for Immunomodulatory Therapy in Warm Autoimmune Hemolytic Anemia

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