scholarly journals Autoimmune hemolytic anemia in COVID-19 patients, the « transmissible » direct Coombs test

2021 ◽  
Vol 5 (1) ◽  
pp. 004-008
Author(s):  
Brochier Alice ◽  
Cabo Julien ◽  
Guerrieri Claudine ◽  
Belkhir Leïla ◽  
Laterre Pierre-François ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Case Reports ◽  
Large Population ◽  
General Ward ◽  
University Hospital ◽  
Blood Transfusions ◽  
Coombs Test ◽  
Intensive Care Patients

Background: Like other viruses, the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) appears to be responsible for several autoimmune complications. The occurrence of autoimmune hemolytic anemia has been described in several case reports. This AIHA was also noticeable by the important number of blood transfusions required for COVID-19 (coronavirus disease 2019) patients. By investigating RBC coating autoantibodies, this article attempts to clarify the autoimmune aspect of the anemia in the context of SARS-CoV-2 infection. Results: A large population of COVID-19 patients selected at Saint-Luc University Hospital showed an average of 44% DAT positivity. In this population, the intensive care patients were more prone to DAT positivity than the general ward patients (statistically significant result). The positive DAT appeared « transmissible » to other RBCs via COVID-19 DAT-positive patient’s plasma. Conclusion: The strongest hypothesis explaining this observation is the targeting of cryptic antigens by autoantibodies in COVID-19 patients.

scholarly journals A Five-Month-Old Infant With Severe Autoimmune Hemolytic Anemia Treated Without Blood Transfusions

2018 ◽  
Vol 9 (9) ◽  
pp. 284-286 ◽  
Author(s):  
Marco Felipe Macedo Alves ◽  
Jardelina Brena Rocha Leite ◽  
Modesto Leite Rolim Neto ◽  
Ricardo Parente Garcia Vieira ◽  
Jacia Maria Neves Coelho ◽  
...  
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Blood Transfusions

The Serology and the Prognosis of 128 Cases of Autoimmune Hemolytic Anemia

Blood ◽  
1959 ◽  
Vol 14 (12) ◽  
pp. 1280-1301 ◽  
Author(s):  
JEAN DAUSSET ◽  
JACQUES COLOMBANI
Keyword(s):  
Hemolytic Anemia ◽  
Lupus Erythematosus ◽  
Autoimmune Hemolytic Anemia ◽  
Early Stage ◽  
Complete Recovery ◽  
Clinical Results ◽  
Red Cells ◽  
Coombs Test ◽  
Long Term Effect ◽  
Corticosteroid Hormones

Abstract A statistical study of 128 cases of autoimmune hemolytic anemias, serologically followed up in the same laboratory, led to some conclusions on classification, prognosis and treatment. Five forms were distinguished: 1. Idiopathic autoimmune hemolytic anemia with warm autoantibodies (IAHA-wa) was the most frequent form (65 per cent of the cases). It was observed in all peroids of life. A slight predominance among females was noted. This form was characterized clinically by a generalized or conjunctival icterus and a moderate splenomegaly. Hematologically a macrocytic normochromic anemia was present and serologically warm incomplete autoagglutinins, often nonspecific, or sometimes specific for a group antigen, were detected. Hemolysins were not found. The average course was 13 months followed by recovery (54 per cent) and 16 months followed by death (46 per cent). These two groups of patients were compared extensively. No differences in the age, sex, blood group and severity of the initial anemia were noted. A low reticulocyte count, leukopenia and association with thrombocytopenic purpura were more frequent in fatal cases. Tile persistence of a positive indirect Coombs test was unfavorable. Those with free antibodies in the plasma were the most serious. Fifty-two per cent of fatal cases had a positive indirect Coombs test. Of those who recovered, 18.5 per cent had this serologic finding. Transfusions were usually done at the begining of the disease. The efficacy of corticosteroid hormones was confirmed; the percentage of recoveries has risen since this therapy has been used fully (37.5 to 70 per cent). Early or late splenectomy had no influence on final desensitization (long-term effect), but led in 58 per cent of the cases to good clinical results (immediate effect). The spleen destroys red cells coated with noncomplement-fixing antibodies, so that splenectomy leads to compensation for the anemia. One must also describe the acute autoimmune hemolytic anemia observed especially in children, in which warm hemolysins could be detected at the very early stage of the disease. Complement was diminished or absent and the serum often showed anticomplementary activity. Complete recovery was rapid. 2. Symptomatic autoimmune hemolytic anemia with warm autoantibodies (SAHA-wa) accompanied mostly malignant conditions of the lymphocytic or reticuloendothelial systems as well as more rarely disseminated lupus erythematosus (17.6 per cent of the cases). Except for the causal disease, these cases were not different from IAHA-wa and their prognosis depended on the prognosis of the causal disorder. 3. Idiopathic autoimmune hemolytic anemia with cold antibodies (IAHAca) was less frequent (7.7 per cent of the cases). Clinically it was characterized by the rarity of splenomegaly, the chance of cold paroxysmal hemoglobinuria (1 case out of 10) and of Raynaud’s syndrome (1 case out of 10), and serologically by the presence of a cold acid-hemolysin (7 cases out of 8) along with an increased titer of complete agglutinins. Complement was diminished or absent. A positive Coombs test was possibly due to complement fixation. The course of these forms seemed to be very chronic: Nine cases of the 10 of the series were in progress for an average of 26 months, without any apparent trend to densensitization. The action of hormone therapy was less striking than in the warm variety. Splenectomy was probably not effective (1 case), since the red cells sensitized by complement-fixing antibodies were mainly recovered by the liver. 4. Symptomatic autoimmune hemolytic anemia wiith cold antibodies (SAHA-ca) was divided into two distinct forms: (a) one symptomatic of a malignant condition of the blood of the same type as in SAHA-wa (7 per cent of cases). The serology was identical to that of IAHA-ca. The prognosis was determined by that of the causal disease; (b) one symptomatic of a virus or a presumed virus infection (3.9 per cent of cases). Here an acid-hemolysin usually accompanied a very high complete cold agglutinin titer. Complete recovery occurred rapidly. In all cases with cold antibodies exposure to cold had to be carefully avoided. In cases of hemolysins, washed red cells had to be used for transfusions.

scholarly journals Autoimmune myelofibrosis associated with autoimmune hemolytic anemia successfully treated with ruxolitinib

2021 ◽  
Author(s):  
Shuku Sato ◽  
Wataru Kamata ◽  
Yotaro Tamai
Keyword(s):  
Bone Marrow ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Transforming Growth Factor ◽  
Myeloproliferative Neoplasms ◽  
Bone Marrow Examination ◽  
Coombs Test ◽  
Bone Marrow Fibrosis ◽  
Cytokine Levels ◽  
Antiglobulin Test

Abstract A 55-year-old man suffered from dyspnea, general malaise, and jaundice. His laboratory date showed pancytopenia and hemolytic anemia, and computed tomography showed splenomegaly. Bone marrow examination revealed myelofibrosis (MF)-1. The hemolytic anemia was diagnosed as IgM autoimmune hemolytic anemia (AIHA) with negative direct and indirect Coombs test but positive IgM-direct antiglobulin test. We started ruxolitinib 20 mg, which improved not only bone marrow fibrosis, symptoms related to myeloproliferative neoplasms and splenomegaly, but also AIHA. AIHA may be associated with Autoimmune MF (AIMF), and cytokines such as transforming growth factor (TGF)-β are thought to be involved in such cases. This case suggests that ruxolitinib may improve the cytokine levels and may lead to the treatment of AIHA as well as AIMF.

scholarly journals Potential drug interactions in intensive care patients at a teaching hospital

2009 ◽  
Vol 17 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Rhanna Emanuela Fontenele Lima ◽  
Silvia Helena De Bortoli Cassiani
Keyword(s):  
Intensive Care ◽  
Drug Interactions ◽  
Signs And Symptoms ◽  
Pharmacokinetic Profile ◽  
University Hospital ◽  
Potential Drug ◽  
Intensive Care Patients ◽  
Adequate Knowledge ◽  
Preventive Actions ◽  
Clinical Action

This study assessed potential drugs interactions in intensive care patients at a university hospital in Ceará, northeast Brazil. Of 102 patients studied, 72.5% were exposed to 311 potential drug-drug interactions; 64% of them were females aged 60 years or more and hospital stay was at least 9 days. A statistically significant association was found between number of drugs used and the occurrence of drug interactions. A total of 1,140 drugs were scheduled to be administered concomitantly; of these, 74% had potential for drug interactions. As for the classification of these events, 48.2% had a pharmacokinetic profile; 55.4% were of slow onset; 54.7% had moderate severity; and 60.6% were well-documented in the literature. The most common clinical action taken was "to monitor signs and symptoms". Nursing staff can perform 80% of preventive actions to avoid undesirable effects of drug interactions. However, nurses need to have adequate knowledge about drug action mechanisms and triggering factors associated to drug interactions.

scholarly journals Autoimmune Hemolytic Anemia Induced by Levofloxacin

2014 ◽  
Vol 2014 ◽  
pp. 1-2
Author(s):  
Marwan Sheikh-Taha ◽  
Pascale Frenn
Keyword(s):  
Emergency Department ◽  
Urinary Tract Infection ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Rare Condition ◽  
White Female ◽  
Coombs Test ◽  
Drug Induced ◽  
Indirect Bilirubin ◽  
Patient Reported

Drug-induced autoimmune hemolytic anemia is a rare condition. We report the case of a 32-year-old white female who presented to the emergency department with generalized fatigue, fever, and jaundice. The patient reported using levofloxacin few days prior to presentation for urinary tract infection. The patient had evidence of hemolytic anemia with a hemoglobin of 6.7 g/dL which dropped to 5 g/dL on day 2, the direct Coombs test was positive, indirect bilirubin was 5.5 mg/dL, and LDH was 1283 IU/L. Further testing ruled out autoimmune disease, lymphoma, and leukemia as etiologies for the patient’s hemolytic anemia. Levofloxacin was immediately stopped with a gradual hematologic recovery within few days.

scholarly journals Trigger alerts associated with laboratory abnormalities on identifying potentially preventable adverse drug events in the intensive care unit and general ward

2018 ◽  
Vol 9 (4) ◽  
pp. 207-217 ◽  
Author(s):  
Mitchell S. Buckley ◽  
Jeffrey R. Rasmussen ◽  
Dale S. Bikin ◽  
Emily C. Richards ◽  
Andrew J. Berry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Adverse Drug Events ◽  
Continuous Process ◽  
General Ward ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Continuous Process Improvement ◽  
Drug Induced

Background Medication safety strategies involving trigger alerts have demonstrated potential in identifying drug-related hazardous conditions (DRHCs) and preventing adverse drug events in hospitalized patients. However, trigger alert effectiveness between intensive care unit (ICU) and general ward patients remains unknown. The objective was to investigate trigger alert performance in accurately identifying DRHCs associated with laboratory abnormalities in ICU and non-ICU settings. Methods This retrospective, observational study was conducted at a university hospital over a 1-year period involving 20 unique trigger alerts aimed at identifying possible drug-induced laboratory abnormalities. The primary outcome was to determine the positive predictive value (PPV) in distinguishing drug-induced abnormal laboratory values using trigger alerts in critically ill and general ward patients. Aberrant lab values attributed to medications without resulting in an actual adverse event ensuing were categorized as a DRHC. Results A total of 634 patients involving 870 trigger alerts were included. The distribution of trigger alerts generated occurred more commonly in general ward patients (59.8%) than those in the ICU (40.2%). The overall PPV in detecting a DRHC in all hospitalized patients was 0.29, while the PPV in non-ICU patients (0.31) was significantly higher than the critically ill (0.25) ( p = 0.03). However, the rate of DRHCs was significantly higher in the ICU than the general ward (7.49 versus 0.87 events per 1000 patient days, respectively, p < 0.0001). Although most DRHCs were considered mild or moderate in severity, more serious and life-threatening DRHCs occurred in the ICU compared with the general ward (39.8% versus 12.4%, respectively, p < 0.001). Conclusions Overall, most trigger alerts performed poorly in detecting DRHCs irrespective of patient care setting. Continuous process improvement practices should be applied to trigger alert performance to improve clinician time efficiency and minimize alert fatigue.

scholarly journals Plasma Leptin Is Increased in Intensive Care Patients with COVID-19—An Investigation Performed in the PronMed-Cohort

Biomedicines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 4
Author(s):  
Anders Larsson ◽  
Miklós Lipcsey ◽  
Michael Hultström ◽  
Robert Frithiof ◽  
Mats Eriksson
Keyword(s):  
Intensive Care ◽  
Blood Donors ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
University Hospital ◽  
Care Hospital ◽  
Median Length ◽  
Intensive Care Patients ◽  
The World ◽  
Plasma Leptin

COVID-19 has shaken the world and intensive care units (ICU) have been challenged by numerous patients suffering from a previously unknown disease. Leptin is a polypeptide pleiotropic hormone, mainly expressed by adipocytes. It acts as a proinflammatory cytokine and is associated with several conditions, known to increase the risk of severe COVID-19. Very little is known about leptin in severe viral disorders. Plasma leptin was analyzed in 222 out of 229 patients with severe COVID-19 on admission to an ICU at Uppsala University Hospital, a tertiary care hospital in Sweden, and compared to plasma leptin in 25 healthy blood donors. COVID-19 was confirmed by positive PCR. Leptin levels were significantly higher in patients with COVID-19 (18.3 ng × mL−1; IQR = 30.4), than in healthy controls (7.8 ng × mL−1; IQR = 6.4). Women had significantly higher leptin values (22.9 ng × mL−1; IQR = 29.8) than men (17.5 ng × mL−1; IQR = 29.9). Mortality at 30 days was 23% but was not associated with increased leptin levels. Neither median duration of COVID-19 before admission to ICU (10 days; IQR = 4) or median length of ICU stay (8 days; IQR = 11) correlated with the plasma leptin levels. Leptin levels in COVID-19 were higher in females than in males. Both treatment (e.g., use of corticosteroids) and prophylaxis (vaccines) have been improved since the start of the COVID-19 pandemic, which may contribute to some difficulties in deciphering relations between COVID-19 and leptin.

scholarly journals Immune-Mediated Hematologic Complications of Checkpoint Inhibitors: A Review of the Literature

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5883-5883 ◽  
Author(s):  
Omar Sallam ◽  
Irbaz Bin Riaz ◽  
Ronald S. Go
Keyword(s):  
Clinical Trials ◽  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Checkpoint Inhibitors ◽  
Case Reports ◽  
Case Series ◽  
Immune Mediated ◽  
Immune Neutropenia

Abstract Background: The incidence and types of hematologic complications from immune check point inhibitors are not well known. We conducted this review to describe immune-mediated hematologic complications reported in clinical trials, case series, and case reports. Methods: A pre-defined comprehensive search strategy was used to identify case reports, case series, and clinical trials using PubMed. Any study that reported hematologic complications was included. Data were extracted for demographic characteristics and occurrence of immune-mediated hematologic complications. We pooled the data to calculate the frequency of immune-mediated hematologic adverse effects. Results: A total of 689 of studies were retrieved using the search criteria and 75 were included in the analysis (31 case reports and case series and 44 clinical trials). There were 44 patients reported having immune-mediated hematologic complications, 4 of them in clinical trials. The complications included aplastic anemia, autoimmune hemolytic anemia, cryoglobulinemia, graft versus host disease, hemophilia A (acquired), immune neutropenia, immune thrombocytopenia, macrophage activation syndrome, myelodysplastic syndrome, pure red cell aplasia, and thrombotic thrombocytopenic purpura. However, the overall rates were very low, ranging from 1-2.2% in clinical trials. Immune thrombocytopenia was the most common (29.5%), followed by autoimmune hemolytic anemia (15.9%), and immune neutropenia (13.6%). Immune-mediated hematologic complications were reported in all classes of checkpoint inhibitors including anti-programmed cell death protein 1 (nivolumab and pembrolizumab), anti-programmed death ligand 1 (avelumab and durvalumab), and anti-cytotoxic T-lymphocyte-associated protein 4 inhibitors (ipilimumab and tremelimumab). Among patients reported in case reports and case series, the median age was 57 years (range, 29-85) and most were males (52.9%). The majority of the complications occurred in patients treated with ipilimumab (38.8%), nivolumab (27.7%) and pembrolizumab (16.0%). The onset was usually within the first week of receiving the first dose but could occur up to 17 months after drug initiation. Indefinite discontinuation of the immunotherapy was the mainstay of treatment resulting in resolution of complications in the majority (74.5%) of the patients. Two patients were re-challenged with the same checkpoint inhibitor and one experienced a relapse of immune cytopenia (autoimmune hemolytic anemia). Conclusion: Immune-mediated hematologic complications associated with checkpoint inhibitors are rare. They are usually reversible after discontinuation of such treatment. Relapses may occur with re-challenge. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document