Cytomegalovirus-Associated Hemolytic Anemia in an Infant Born to a Mother with Lupus

A 31-day-old infant was admitted to the pediatric intensive care unit due to shock and anemia. The mother had systemic lupus erythematosus and direct antiglobulin test (DAT)-positive hemolytic anemia. The perinatal course of this infant and the mother was uneventful. Regular health check screenings revealed that activity, growth, and development were unremarkable at birth, 5, and 28 days of life. Passive immune hemolytic anemia due to neonatal lupus erythematosus was diagnosed based on a positive DAT for warm-type IgG antibodies, reticulocytosis, and lupus-specific antibodies at rehospitalization. It was complicated by cytomegalovirus (CMV) antigenemia. Umbilical cord blood and peripheral blood samples obtained from the infant at 5 days after birth were negative for CMV DNA. The infant was curatively treated by intensive care with repeated blood transfusions and antiviral therapy. This is the first report indicating that CMV infection exacerbates hemolytic anemia in patients with maternal red blood cell alloantibodies.

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Diagnosis of Auto Immune Hemolytic Anemia by Detection of RBC-Bound IgG Antibodies, Using Flow-Cytometry

Blood ◽

10.1182/blood.v120.21.5159.5159 ◽

2012 ◽

Vol 120 (21) ◽

pp. 5159-5159

Author(s):

Jitendra Mohan Khungar ◽

Hara Prasad Prasad Pati ◽

Manoranjan Mahapatra

Keyword(s):

Flow Cytometry ◽

Hemolytic Anemia ◽

False Negative ◽

Direct Antiglobulin Test ◽

Igg Antibodies ◽

Immune Hemolytic Anemia ◽

Antiglobulin Test ◽

Low Levels ◽

Positive Direct ◽

Card Test

Abstract Abstract 5159 Introduction: Auto Immune Hemolytic Anemia (AIHA) is one of the most common types of acquired hemolytic anaemias. Its main cause is auto antibody mediated rapid destruction of RBCs. Detection of these autoantibodies to erythrocytes is of fundamental importance for diagnosis. A number of methodologies have been tried for detection & evaluation of these autoantibodies. Demonstration of a positive Direct Antiglobulin Test (DAT) against these autoantibodies is an important serological assay in the diagnosis of auto immune hemolytic anemia (AIHA). This test is also considered as pathognomonic of immune-mediated hemolysis. This routinely used direct antiglobulin test (DAT) has the disadvantage of low sensitivity and does not detect low levels of red cell auto antibodies leading sometimes to false negative results. Flow cytometry can effectively diagnose such patients of auto immune hemolytic anemia with low levels of autoantibodies. Role of flow cytometry in the diagnosis of several non-malignant haematological disorders is being explored & present study has been conducted with the same objective. Aims & Objectives: This study was conducted with the following aims and objectives: •To assess the utility of flow-cytometry (FCM) in the diagnosis of suspected AIHA patients. •Compare the sensitivity of flow-cytometry (FCM) with Direct Antiglobulin Test (DAT) by Gel-card Test (GT). •To assess the positivity in DAT negative cases by flow-cytometry in suspected AIHA cases. Material & Methods: This was a prospective study, carried out in Haematology Deptt of All India Institute of Medical Sciences, where patients with suspected auto immune hemolytic anemia (AIHA) were studied during two years period. Blood samples of suspected patients of AIHA were tested by Gel Card Test as well as by Flow cytometry for detection of RBC bound IgG. Results: A total of 50 patients with suspected diagnosis of auto immune hemolytic anemia (AIHA) were studied by flow-cytometry as well as by Gel card test (GT) for detection of RBC bound IgG. Out of these 50 cases, 41 cases have turned out to be positive and 9 were negative by flow-cytometry. The quantification of positivity by flow-cytometry was obtained by calculating percentage fluorescence. The same 50 cases were also tested by Gel card test (GT). By Gel card test, out of 50 cases, 34 were positive & 16 were negative. Therefore, there were 7 cases which were negative for RBC bound IgG by Gel card test and these were positive by flow-cytometry. The flow cytometry figures of these cases will be shown & discussed in the presentation. Conclusions: Flow-cytometry is a reliable and sensitive method of detecting RBC-bound IgG antibodies for the diagnosis of auto immune hemolytic anemia. This can be used as a new routine diagnostic technique for auto immune hemolytic anemia. Disclosures: No relevant conflicts of interest to declare.

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Neonatal Lupus Erythematosus: Maternal IgG Antibodies Bind to a Recombinant NH2-Terminal Fusion Protein Encoded by Human α-Fodrin cDNA

Journal of Investigative Dermatology ◽

10.1046/j.1523-1747.1998.00440.x ◽

1998 ◽

Vol 111 (6) ◽

pp. 1189-1192 ◽

Cited By ~ 20

Author(s):

Sachiko Miyagawa ◽

Toshihiko Shirai ◽

Kumiko Yanagi ◽

Akira Yoshioka ◽

Kin-ichi Kidoguchi ◽

...

Keyword(s):

Fusion Protein ◽

Lupus Erythematosus ◽

Igg Antibodies ◽

Neonatal Lupus ◽

Neonatal Lupus Erythematosus ◽

Maternal Igg

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Warm antibody hemolytic anemia—a rare presentation of neonatal lupus

Lupus ◽

10.1177/0961203316664594 ◽

2016 ◽

Vol 26 (6) ◽

pp. 661-663 ◽

Cited By ~ 1

Author(s):

Rohan Halder ◽

Richa Malik ◽

Rajesh Kashyap

Keyword(s):

Hemolytic Anemia ◽

Transient Response ◽

Lupus Erythematosus ◽

Neonatal Lupus ◽

Rare Presentation ◽

Neonatal Lupus Erythematosus ◽

Cyclosporin Therapy ◽

Pregnant Females ◽

Steroid Refractory

Neonatal lupus erythematosus (NLE) affects 1%–2% pregnant females with autoimmunity. An infant presented with steroid refractory hemolytic anemia as a manifestation of NLE. A trial of withholding breastfeeding had a transient response, but infant was eventually put on cyclosporin therapy to control the hemolysis. Now he is thriving well and transfusion free.

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Neonatal lupus erythematosus presenting with rash, thrombocytopenia compounded by cytomegalovirus colonisation: a diagnostic dilemma

BMJ Case Reports ◽

10.1136/bcr-2019-233873 ◽

2020 ◽

Vol 13 (6) ◽

pp. e233873

Author(s):

Gopal Agrawal ◽

Bincy Varghese ◽

Manish Balde ◽

Sanjay Wazir

Keyword(s):

Lupus Erythematosus ◽

Organ Damage ◽

Skin Lesions ◽

Maternal Serum ◽

Cmv Infection ◽

Neonatal Lupus ◽

Cutaneous Lesions ◽

Diagnostic Dilemma ◽

Neonatal Lupus Erythematosus ◽

Erythematous Skin

Neonatal lupus erythematosus (NLE) should be considered when a newborn develops atrioventricular heart block along with the presence of autoantibodies to Sjogren’s syndrome autoantigens in the maternal serum. NLE can also present with features such as cutaneous lesions, hepatic dysfunction or haematological abnormalities. Differential diagnosis usually includes congenital infections as there is a significant overlap of symptoms with NLE. We report a case of NLE who had multiorgan involvement with macular erythematous skin lesions present at birth, and on investigation was found to have cytomegalovirus (CMV) infection. The diagnostic dilemma was whether to consider this infection as symptomatic or just colonisation. In the infant described, the absence of end organ damage specific to CMV infection (hearing loss, intracranial calcifications, retinitis, brain involvement) made a diagnosis of symptomatic CMV unlikely.

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