Treatment of post‐transfusion hyperhaemolysis syndrome in Sickle Cell Disease with the anti‐IL6R humanised monoclonal antibody Tocilizumab

Sivapalaratnam, Suthesh; Linpower, Lisa; Sirigireddy, Bala; Agapidou, Alexandra; Jain, Susan; Win, Nay; Tsitsikas, Dimitris A.

doi:10.1111/bjh.16103

Cited by 19 publications

(26 citation statements)

References 5 publications

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“…Assuming that macrophage activation is critical in severe HTR pathophysiology, tocilizumab (an anti-IL6R antibody) has previously been successfully used in SCD patients with hyperhaemolysis and may be a potential treatment in this setting. 10 In conclusion, we describe here the first case of HLH secondary to HTR due to anti-Wr a in a patient with MDS. Evolution was spontaneously favourable without any specific treatment.…”

mentioning

confidence: 63%

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wr^a in a patient with myelodysplastic syndrome

Contejean

Barreau

Peyrard

et al. 2020

Transfusion Medicine

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mentioning

confidence: 63%

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wr^a in a patient with myelodysplastic syndrome

Contejean

Barreau

Peyrard

et al. 2020

Transfusion Medicine

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“…The use of IL-6 inhibitors like tocilizumab has been considered since researchers have noted high concentrations of proinflammatory cytokines, such as IL-6 in severe SARS-CoV-2 infections [ 8 ]. It has also been shown to be effective in patients who develop hyperhemolysis in the setting of SCD [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Hyperhemolysis in the Setting of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19

Narula¹,

Winkle²,

Brand³

et al. 2021

Cureus

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel human pathogen known for its predilection on the respiratory system. Herein, we present a unique case in which a patient developed hyperhemolysis in the setting of mixed autoimmune hemolytic anemia (AIHA) secondary to SARS-CoV-2. A 33-years-old male with a past medical history of resolved immune thrombocytopenic purpura (ITP) presented to the hospital with symptoms of jaundice after being infected with SARS-CoV-2. On admission, his Hgb was 12.5 g/dL. Lab results showed indirect bilirubin of 13 mg/dL, LDH at 759 U/L, haptoglobin <10, and the percent reticulocyte count was 2.33%. A direct antiglobulin test (DAT) was also positive for C3, IgG, anti-E, in addition to both warm and cold autoantibodies. PCR was positive for COVID-19. Within two days of admission, his Hgb dropped to 5.9 g/dL. A total of seven units of packed red blood cell (pRBC) was required to achieve a Hgb of 6 g/dL in 48 hours. Patients with preexisting hematological abnormalities have a propensity to develop AIHA in the setting of the virus. The majority of the cases described in the literature were associated with warm AIHA. Our patient tested positive for both warm and cold antibodies, which may partially explain the mechanism behind hyperhemolysis in our patient.

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“… 85-92 Case reports have also described treatment of hyperhemolysis with tocilizumab, a monoclonal antibody against the interleukin-6 receptor. 93-95 These cases showed marked improvement after targeted antiinterleukin- 6 receptor therapy, suggesting that blockade of macrophage activation may be an effective treatment strategy. Table 2 summarizes published reports describing use of eculizumab and tocilizumab in patients with SCD.…”

Section: Additional Complications Of Packed Red Blood Cell Transfusionmentioning

confidence: 96%

Red cell transfusion and alloimmunization in sickle cell disease

Linder

Chou

2021

haematol

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Red cell transfusion remains a critical component of care for acute and chronic complications of sickle cell disease. Randomized clinical trials demonstrated the benefits of transfusion therapy for prevention of primary and secondary strokes and postoperative acute chest syndrome. Transfusion for splenic sequestration, acute chest syndrome, and acute stroke are guided by expert consensus recommendations. Despite overall improvements in blood inventory safety, adverse effects of transfusion are prevalent among patients with sickle cell disease and include alloimmunization, acute and delayed hemolytic transfusion reactions, and iron overload. Judicious use of red cell transfusions, optimization of red cell antigen matching, and the use of erythrocytapheresis and iron chelation can minimize adverse effects. Early recognition and management of hemolytic transfusion reactions can avert poor clinical outcomes. In this review, we discuss transfusion methods, indications, and complications in sickle cell disease with an emphasis on alloimmunization.

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Treatment of post‐transfusion hyperhaemolysis syndrome in Sickle Cell Disease with the anti‐IL6R humanised monoclonal antibody Tocilizumab

Cited by 19 publications

References 5 publications

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wr^a in a patient with myelodysplastic syndrome

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wr^a in a patient with myelodysplastic syndrome

Hyperhemolysis in the Setting of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19

Red cell transfusion and alloimmunization in sickle cell disease

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Treatment of post‐transfusion hyperhaemolysis syndrome in Sickle Cell Disease with the anti‐IL6R humanised monoclonal antibody Tocilizumab

Cited by 19 publications

References 5 publications

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wra in a patient with myelodysplastic syndrome

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wra in a patient with myelodysplastic syndrome

Hyperhemolysis in the Setting of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19

Red cell transfusion and alloimmunization in sickle cell disease

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Product

Resources

About

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wr^a in a patient with myelodysplastic syndrome

Hemophagocytic lymphohystiocytosis after haemolytic transfusion reaction due to anti‐Wr^a in a patient with myelodysplastic syndrome