scholarly journals Management of Autoimmune Hemolytic Anemia in the Midst of Coronavirus Disease 2019 Pandemic: A Case Report

Medicinus ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. 223
Author(s):  
Andree Kurniawan ◽  
Devina Adella Halim
Keyword(s):  
Body Weight ◽  
Case Report ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Immunosuppressive Drugs ◽  
High Dose ◽  
Cell Surface Antigens ◽  
Indirect Bilirubin ◽  
Life Threatening ◽  
Novel Coronavirus

<p><strong>Introduction : </strong>The novel coronavirus disease 2019 (COVID-19) has become a pandemic involving all people and can be severe and life-threatening in a certain population such as those with comorbidity. Autoimmune hemolytic anemia (AIHA) is an autoimmune hematologic disease characterized with antibodies production that binds to red cell surface antigens. In this pandemic, several concerns have been raised by autoimmune disease clinicians and patients regarding the use of immunosuppressive drugs. In this case report, we illustrate the problems of autoimmune hemolytic anemia patient when she got active case.</p><p><strong>Case Illustration : </strong>A 28 years old lady was admitted to the hospital owing to fatigue and tiredness during exercise for two weeks. She had been diagnosed with autoimmune hemolytic anemia before and did not comply with the treatment. This patient has been reevaluated of having AIHA from the symptoms of fatigue, enlarged spleen, low hemoglobin, increased reticulocytes, signs of hemolytic in blood smear examination, increased indirect bilirubin, LDH and the Combs’ test result was given positive. She received methylprednisolone 2 mg/kg of body weight intravenously, washed packed red cells (PRC), calcium and proton pump inhibitor. She was discharged at the seventh day since admission and she was prescribed oral methylprednisolone equal to 1 mg/kg body weight.</p><p><strong>Conclusion : </strong>This is an educated case of non-compliance of AIHA that should be given high dose steroid and blood transfusion during hospitalization amid the COVID-19 pandemic. The recommendation of treatment for AIHA was still the same as before the pandemic occured.</p>

Expression of CD47, CD35, CD55 and CD59 on Red Cells from Patients with Warm Autoimmune Hemolytic Anemia.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3738-3738
Author(s):  
Melca O. Barros ◽  
Mihoko Yamamoto ◽  
Maria S. Figueiredo ◽  
Elisa Y. Kimura ◽  
Jose Orlando Bordin
Keyword(s):  
Hemolytic Anemia ◽  
Lupus Erythematosus ◽  
Autoimmune Hemolytic Anemia ◽  
Experimental Studies ◽  
Red Cells ◽  
High Dose ◽  
Healthy Controls ◽  
Life Threatening ◽  
Positive Direct ◽  
Cd59 Expression

Abstract Autoimmune hemolytic anemia (AIHA) is defined as an increased destruction of red cells (RBC) in the presence of anti-RBC autoantibodies. CD47 is an integrin-associated protein expressed on all cells including RBCs. Animal models show that CD47 deficiency contributes to accelerated development of AIHA, while CD35 (CR1- complement receptor 1), CD55 (decay accelerating factor), and CD59 (membrane inhibitor of reactive lysis) are complement inhibitory proteins. Using flow cytometry analysis, in this study we evaluated the expression of CD47, CD35, CD55, and CD59 on RBCs of patients with warm AIHA before any treatment had been initiated. The study population consisted of 12 patients with active AIHA [M:F = 6:6, median age: 32 yrs (3 – 73)], and 20 healthy controls [M:F = 9:11, median age: 36 yrs (25 – 71)]. Ten patients presented idiopathic AIHA while 2 subjects had secondary AIHA (systemic lupus erythematosus and non-Hodgkin’s lymphoma). At presentation the median Hb level was 6.6 mg/dL (range: 2.9 to 10 mg/dL), and the median absolute reticulocyte count was 324 × 109/L (range: 215 to 756 × 109/L). At the time of the analyses, all 12 patients had a positive direct antiglobulin test (DAT), 12 (100%) had IgG on their RBCs, 5 (41.7%) had IgG plus C3, and none had C3 alone. The strength of agglutination of all positive DATs showed a strong reaction. The RBC eluates prepared by a dichloromethane technique from the cell samples were positive in all 12 patients, but the retrieved autoantibodies were pan-reactive showing no specific reactivity. The mean fluorescence intensity (MFI) of the expression of CD47, CD35 and CD55 on RBCs of AIHA patients and healthy individuals were not statistically different (CD47 = 464.4 and 464.4; CD35 = 186.8 and 194.3; CD55 = 396.9 and 381.1, respectively). Four patients with life-threatening AIHA were treated with high dose of steroids and RBC transfusions, but 3 patients evolved to death. Two patients who died presented low CD55 expression on their RBCs at diagnosis. AIHA patients showed significant lower CD59 expression on RBCs than healthy controls (MFI = 512.3 ± 28.0 and 553.7 ± 36.6, P = .03). Although CD59 expression in patients that evolved to remission was not significantly different from healthy controls (MFI = 538.5 ± 14.4 and 553.7 ± 36.6), the expression of CD59 on RBCs of 3 AHAI patients who died were significantly lower than that seen on RBCs of healthy controls (MFI = 433.6 ± 69.6 and 553.7 ± 36.6, P = .0001). Although experimental studies have suggested that CD47 has a profound influence on the severity of AIHA in mice, our preliminary data on 12 patients with AIHA did not demonstrate difference on the expression of CD47 on RBCs of patients with warm AIHA or healthy indibiduals. On the other hand, complement regulatory proteins (CD35, CD55, and CD59) may play an important role in protecting RBC destruction through the activation of complement. Our results suggest that patients with life-threatening warm AIHA may present significant CD59 deficiency on their RBCs that may increase the susceptibility of cells to complement-mediated lysis resulting in severe clinical hemolysis.

scholarly journals Case Report: COVID 19 infection induced Autoimmune Hemolytic Anemia

2021 ◽  
pp. 248
Author(s):  
Keyword(s):  
Case Report ◽  
Hemolytic Anemia ◽  
Organ Dysfunction ◽  
Autoimmune Hemolytic Anemia ◽  
Autoimmune Disorders ◽  
High Dose ◽  
The Us ◽  
Asymptomatic Disease

SARS-CoV 2 was designated a pandemic by WHO on March of 2019. There have been over 120 million confirmed cases of COVID-19 globally with greater than 4 million hospitalizations in the US alone. These cases can range from asymptomatic disease to multi-organ dysfunction resulting in death. The spectrums of complications stemming from COVID-19 are much broader and can include other autoimmune disorders. Here we present a case of a woman who developed autoimmune hemolytic anemia from COVID-19 infection and was successfully treated with high dose corticosteroids.

Unusually Severe Course of Autoimmune Hemolytic Anemia / Cold Agglutinin Disease: A Case Report

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S165-S165
Author(s):  
M M Yilmaz ◽  
Y Tanhehco
Keyword(s):  
Case Report ◽  
Plasma Exchange ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Middle Lobe ◽  
Cold Agglutinin ◽  
Upper Respiratory Tract ◽  
Cold Agglutinin Disease ◽  
Cell Surface Antigens ◽  
Short Period

Abstract Introduction/Objective Autoimmune hemolytic anemia (AIHA) is a group of disorders with limited epidemiological and clinical data, characterized by hemolysis due to autoantibodies against red blood cell surface antigens. Cold agglutinins account for about 25% of all AIHA, which can agglutinate erythrocytes at 0-4 °C. Cold agglutinin disease (CAD) is a self limited disease and usually does not cause significant hemolysis. Here, we report a case with an unusually severe course for secondary CAD and role of plasma exchange in the management. Methods A 53-year-old male patient with no known past medical history presented to the emergency department with shortness of breath and syncope after a week of upper respiratory tract infection symptoms. The patient became profoundly anemic (presented with 8.1 g/dL hemoglobin level and progressively decline to 4.2 g/dL) in a short period of time. Upon initial evaluation, his peripheral blood smear demonstrated clumps of RBCs. Direct anti-globulin testing was negative for IgG but positive for C3 which is consistent with CAD. A respiratory PCR panel detected Rhinovirus. Mycoplasma and EBV IgM were negative. Additionally, chest X-ray showed right middle lobe pneumonia that was treated with antibiotics. Patient received multiple transfusions of pre-warmed pRBCS and showed initial improvement but eventually went into respiratory failure and cardiac arrest with return of spontaneous circulation after 8 minutes of CPR. Subsequently, plasma exchange was started. Only after intiation of plasma exchange, the patient’s ongoing hemolysis was stabilized. Conclusion This case report presents a patient with unexpectedly rapid and severe hemolysis from secondary cold agglutinin disease. Interestingly, the case appeared not to be caused by EBV or Mycoplasma pneumonia infection but Rhinovirus. Further studies confirmed patient had no autoimmune disorder or lymphoid malignancy that may had initiated secondary CAD. On the management aspect, pre-warmed RBC transfusions were not sufficient to stabilize the patient’s condition. Plasma exchange was able to control ongoing hemolysis within 2 sessions successfully.

Giant cell hepatitis and Coomb’s positive autoimmune hemolytic anemia: a case report and literature review

2014 ◽  
Vol 25 (1) ◽  
Author(s):  
Hasan M. Isa ◽  
◽  
Lina F. Al Ali ◽  
Afaf M. Mohamed ◽  
Rawia M. Hamad ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Giant Cell ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Giant Cell Hepatitis

scholarly journals Autoimmune Hemolytic Anemia as a Complication of Congenital Anemias. A Case Series and Review of the Literature

2021 ◽  
Vol 10 (15) ◽  
pp. 3439
Author(s):  
Irene Motta ◽  
Juri Giannotta ◽  
Marta Ferraresi ◽  
Kordelia Barbullushi ◽  
Nicoletta Revelli ◽  
...  
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Case Series ◽  
Intravenous Immunoglobulins ◽  
Point Of View ◽  
First Line ◽  
Human Erythropoietin ◽  
Immune Mediated ◽  
Hemolytic Crisis ◽  
Life Threatening

Congenital anemias may be complicated by immune-mediated hemolytic crisis. Alloantibodies are usually seen in chronically transfused patients, and autoantibodies have also been described, although they are rarely associated with overt autoimmune hemolytic anemia (AIHA), a serious and potentially life-threatening complication. Given the lack of data on the AIHA diagnosis and management in congenital anemias, we retrospectively evaluated all clinically relevant AIHA cases occurring at a referral center for AIHA, hemoglobinopathies, and chronic hemolytic anemias, focusing on clinical management and outcome. In our cohort, AIHA had a prevalence of 1% (14/1410 patients). The majority were warm AIHA. Possible triggers were recent transfusion, infection, pregnancy, and surgery. All the patients received steroid therapy as the first line, and about 25% required further treatment, including rituximab, azathioprine, intravenous immunoglobulins, and cyclophosphamide. Transfusion support was required in 57% of the patients with non-transfusion-dependent anemia, and recombinant human erythropoietin was safely administered in one third of the patients. AIHA in congenital anemias may be challenging both from a diagnostic and a therapeutic point of view. A proper evaluation of hemolytic markers, bone marrow compensation, and assessment of the direct antiglobulin test is mandatory.

Refractory eosinophilic fasciitis successfully treated with infliximab: A case report

2021 ◽  
pp. 239719832110043
Author(s):  
Paulina Śmigielska ◽  
Justyna Czarny ◽  
Jacek Kowalski ◽  
Aleksandra Wilkowska ◽  
Roman J. Nowicki
Keyword(s):  
Case Report ◽  
Connective Tissue ◽  
Treatment Failure ◽  
Immunosuppressive Drugs ◽  
Unknown Etiology ◽  
High Dose ◽  
Eosinophilic Fasciitis ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Eosinophilic fasciitis is a rare connective tissue disease of unknown etiology. Therapeutic options include high-dose corticosteroids and other immunosuppressive drugs. We present a typical eosinophilic fasciitis case, which did not respond to first-line treatment, but improved remarkably after infliximab administration. This report demonstrates that in case of initial treatment failure, infliximab might be a relatively safe and effective way of eosinophilic fasciitis management.

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

scholarly journals NUDT15 polymorphism explains serious toxicity to azathioprine in Indian patients with chronic immune thrombocytopenia and autoimmune hemolytic anemia: a case series

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Anup J. Devasia ◽  
Raveen Stephen Stallon Illangeswaran ◽  
Infencia Xavier Raj ◽  
Biju George ◽  
Poonkuzhali Balasubramanian
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Immune Thrombocytopenia ◽  
Case Series ◽  
Severe Toxicity ◽  
Toxic Side Effect ◽  
Case Presentation ◽  
Oral Ulcers ◽  
Asian Patients ◽  
Life Threatening

AbstractObjectivesAzathioprine (AZA) is a commonly used immunosuppressant in patients with autoimmune diseases. The toxic side effect to AZA (myelosuppression, hair loss, and oral ulcers) are highly unpredictable which can be life threatening if not identified earlier and dose adjustments made or the drug is withdrawn.Case presentationHere we report a case series of five patients with severe toxicity while on treatment with AZA for autoimmune hemolytic anemia (n=1) and Immune thrombocytopenia (n=4). The common thiopurine methyltransferase (TPMT) variants (TPMT*2, *3A, *3B) were not present in these patients. However, all these patients had the NUDT15 415C>T variant that has been reported to explain serious toxicity to thioguanine in Asian patients.ConclusionsOur report suggests pre-emptive genotype-based dosing of AZA could reduce adverse toxicity and hence better outcome.

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