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Diagnostic Splenectomy: Characteristics, Pre-Operative Investigations, and Identified Pathologies for 20 Patients. J Clin Med 2021; 10:jcm10071519. [PMID: 33917291 PMCID: PMC8038722 DOI: 10.3390/jcm10071519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
Splenectomy is indicated in cases of trauma to the spleen or hematological and immunological diseases (hereditary spherocytosis, autoimmune cytopenia). Less frequently, splenectomy is performed for diagnostic purposes to complement unsuccessful prior etiological investigations. The splenectomy remains a surgery at risk of complications and should be considered as a last-resort procedure to make the diagnosis and to be able to treat patients. We studied the medical files of 142 patients who underwent a splenectomy for any reason over a 10-year period and identified 20 diagnostic splenectomies. Diagnostic splenectomies were mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin for 10. The other patients had surgery for other causes (cytopenia, abdominal symptoms, suspicion of relapsing malignant hemopathies). Splenectomy contributed to the final diagnosis in 19 of 20 cases, corresponding mostly to lymphoid hemopathies (14/20). The most frequent disease was diffuse large B-cell lymphoma (8/20). Splenectomy did not reveal any infectious disease. The most relevant pre-operative procedures to aid the diagnosis were 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and immuno-hematological examinations. Diagnostic splenectomy is useful and necessary in certain difficult diagnostic situations. Highlights: Diagnostic splenectomy is still useful in 2020 to diagnose unexplained splenomegaly or fever of unknown origin. Lymphoma was the most common final diagnosis. FDG PET/CT was the most useful tool to aid in the diagnosis.
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Rivas S, Vidon C, Vial T, Auffret M. Secukinumab-Induced Acute Autoimmune Hemolytic Anemia. Ann Pharmacother 2020; 54:933-934. [DOI: 10.1177/1060028020907202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Lauda-Maillen M, Catroux M, Roy-Peaud F, Souchaud-Debouverie O, El Masmouhi B, Roblot P. Diagnostic et prise en charge de l’anémie hémolytique auto-immune à l’exclusion des formes secondaires à une cause néoplasique. Adéquation de la prise en charge au PNDS octobre 2009. Rev Med Interne 2017; 38:648-655. [DOI: 10.1016/j.revmed.2017.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/15/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
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Uwingabiye J, Zahid H, Labrini F, El Khazraji A, Yahyaoui A, Hadef R, Messaoudi N. Severe hemolytic disease of the premature newborn due to RH1 incompatibility: a case report. ACTA ACUST UNITED AC 2016; 89:565-568. [PMID: 27857529 PMCID: PMC5111500 DOI: 10.15386/cjmed-578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 07/01/2016] [Accepted: 09/12/2016] [Indexed: 12/25/2022]
Abstract
We report a case of dramatic outcome of severe hemolytic disease in a newborn due to RH1 incompatibility. A newborn with A RH1 blood group was admitted in the Mohammed V Military Teaching Hospital for the problem of hydrops fetalis associated with RH1 incompatibility. The blood group of his mother, aged 31, was AB RH1-negative and that of his 37 year old father was A RH1. The mother had a history of 4 term deliveries, 3 abortions, and 1 living child. There was no prevention by anti-D immunoglobulin postpartum. The mother’s irregular agglutinin test was positive and the pregnancy was poorly monitored. The laboratory tests of the newborn showed a high total serum bilirubin level (30 mg/L) and macrocytic regenerative anemia (Hemoglobin=4 g/dL, mean corpuscular volume = 183 fL, reticulocytes count =176600/m3). The blood smear showed 1256 erythroblasts per 100 leukocytes, Howell–Jolly bodies and many macrocytes. The direct antiglobulin test was positive. He was transfused with red blood cell concentrates and treated with conventional phototherapy. The evolution was unfavourable; he died three days after the death of his mother. The monitoring of these high-risk pregnancies requires specialized centers and a close collaboration between the gynaecologist and the blood transfusion specialist to strengthen the prevention, as well as clinico-biological monitoring in patients with a history of RH1 fetomaternal alloimunization.
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Affiliation(s)
- Jean Uwingabiye
- Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hafid Zahid
- Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Fayçal Labrini
- Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelhak El Khazraji
- Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Anass Yahyaoui
- Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Rachid Hadef
- Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Nezha Messaoudi
- Laboratory of Hematology and Immunohematology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Zulfiqar AA, Pennaforte JL, Andres E. Autoimmune Hemolytic Anemia in Individuals Aged 75 and Older: A Study of 10 Individuals. J Am Geriatr Soc 2016; 64:1372-4. [DOI: 10.1111/jgs.14167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Department of Internal Medicine and Geriatrics; University Hospital of Reims; Reims France
| | | | - Emmanuel Andres
- Department of Internal Medicine; University Hospital of Strasbourg; Strasbourg France
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Anémie hémolytique auto-immune de l’enfant. Transfus Clin Biol 2015; 22:291-8. [DOI: 10.1016/j.tracli.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022]
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Alzate MA, Manrique LG, Bolaños NI, Duarte M, Coral-Alvarado P, González JM. Simultaneous detection of IgG, IgM, IgA complexes and C3d attached to erythrocytes by flow cytometry. Int J Lab Hematol 2014; 37:382-9. [PMID: 25269888 DOI: 10.1111/ijlh.12297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 09/02/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Immune complexes attached to erythrocyte membrane are involved in autoimmune hemolytic anemia (AIHA) pathogenesis. Currently, direct antiglobulin test (DAT) is used for AIHA diagnosis; however, its performance can be variable. The aim of this study was to design a flow cytometry protocol for simultaneous detection of IgG, IgM, IgA immune complexes and C3d attached to erythrocytes in AIHA patients . METHODS A procedure was standardized for assessing independent or simultaneous IgG, IgM, IgA immune complexes and C3d, which were detected using secondary antibodies. The protocol developed was applied to blood samples of patients with AIHA, donors at risk of developing the disease, and healthy controls. RESULTS Twenty-four blood samples were assessed: nine patients with AIHA, five donors at risk of developing the disease, and 10 healthy controls. In the AIHA group, all were positive for C3d, seven for IgG, four for IgA, and one for IgM. Two AIHA patients that were negative for DAT-IgG and C3d were positive for C3d by flow cytometry. CONCLUSION Flow cytometry is a consistent method for identifying the presence of IgG, IgM, IgA immune complexes and C3d attached to erythrocytes and can be helpful for understanding the mechanisms involved in AIHA pathogenesis.
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Affiliation(s)
- M A Alzate
- Grupo de Ciencias Básicas Médicas, School of Medicine, Universidad de los Andes, Bogotá, DC, Colombia
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Pasquet F, Pavic M, Ninet J, Hot A. [Auto-immune diseases and cancers. Second part: auto-immune diseases complicating cancers and their treatment]. Rev Med Interne 2014; 35:656-63. [PMID: 25106665 DOI: 10.1016/j.revmed.2014.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/27/2014] [Accepted: 04/14/2014] [Indexed: 12/18/2022]
Abstract
Autoimmune diseases may reveal or occur during the course of a neoplasia or its treatment. Autoimmune cytopenia, especially haemolytic anaemia, is common in lymphoproliferative disorders such as chronic lymphoid leukemia. The link between cancer and myositis is well established. Dermatomyositis is associated with an increased relative risk of cancer of 3.4 to 4.4. A combination of detection of antibodies against p155 and TEP-computed tomography may be the best approach to ascertain the presence of occult malignancy in patients with dermatomyositis. A cutaneous or a systemic vascularitis may reveal a cancer, most often a haematological malignancy such as hairy cell leukemia. Paraneoplastic polyarthritis have been described in particular with adenocardinoma of the lungs. Underlying neoplasia should be considered in male smokers patients with new onset polyarthritis and poor health status. The prevalence of autoimmune conditions in myelodysplastic syndromes is 10 to 30%. Vasculitis and relapsing polychondritis are the most commonly reported manifestations. Immune manifestations can also be related to treatment. The most common treatment complications are autoimmune haemolytic anaemia with fludarabine and thyroiditis related to interferon and cervical radiotherapy.
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Affiliation(s)
- F Pasquet
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France.
| | - M Pavic
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
| | - A Hot
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
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Michel M. Diagnostic d’une anémie hémolytique en réanimation. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-013-0710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gokce M, Bilginer Y, Besbas N, Ozaltın F, Cetin M, Gumruk F, Ozen S. Hematological features of pediatric systemic lupus erythematosus: suggesting management strategies in children. Lupus 2012; 21:878-84. [DOI: 10.1177/0961203312443721] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aim: The aim of this study was to analyze the hematological features in children with systemic lupus erythematosus (SLE) and to review our current treatment protocols. Methods: We evaluated hematological findings of 43 children with SLE diagnosed and followed at the Pediatric Rheumatology Division of Hacettepe University, Turkey. Thirty-seven patients with hematological abnormalities were analyzed in detail. Results: Median age at presentation was 13 years. Hematological involvement was seen in 86% of patients. The most common hematological finding was anemia ( n = 30). Anemia was either a Coombs (+) hemolytic one, or was due to other causes. Hemolytic anemia was treated with steroids and intravenous gamma globulin (IVIG). Leucopenia and thrombocytopenia were detected in 35.1 % and 37.8 %, respectively. Bone marrow aspiration was performed in 15, mainly for cytopenia. Secondary dysplastic changes were common. Acute lymphoblastic leukemia (ALL) was diagnosed in one patient. Six patients were diagnosed as having macrophage activation syndrome (MAS). One patient died due to secondary infections and multiorgan failure despite aggressive treatment. In patients diagnosed early, treatment with steroids and cyclosporine resulted in an excellent response. Thrombotic microangiopathy was detected in two patients. Both were treated successfully with steroids and plasma exchange. Antiphospholipid and anticardiolipin antibodies were positive in 12 and 15 of the patients, respectively. Five developed deep vein thrombosis (DVT), one cerebral sinus thrombosis and one presented with purpura fulminans. They were effectively treated with anticoagulation protocol. Conclusion: Hematological findings should be carefully assessed and treated vigorously to prevent the morbidity and possible mortality.
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Affiliation(s)
- M Gokce
- Hacettepe University, School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Y Bilginer
- Hacettepe University, School of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - N Besbas
- Hacettepe University, School of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - F Ozaltın
- Hacettepe University, School of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
| | - M Cetin
- Hacettepe University, School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - F Gumruk
- Hacettepe University, School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - S Ozen
- Hacettepe University, School of Medicine, Department of Pediatric Rheumatology, Ankara, Turkey
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Eddou H, Helissey C, Konopacki J, Souleau B, de Revel T, Malfuson JV. Syndrome d’Evans : attention aux diagnostics par excès. Rev Med Interne 2012; 33:155-8. [DOI: 10.1016/j.revmed.2011.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/06/2011] [Accepted: 12/18/2011] [Indexed: 01/23/2023]
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Sève P, Philippe P, Dufour JF, Broussolle C, Michel M. Autoimmune hemolytic anemia: classification and therapeutic approaches. Expert Rev Hematol 2011; 1:189-204. [PMID: 21082924 DOI: 10.1586/17474086.1.2.189] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autoimmune hemolytic anemia (AIHA) is a relatively uncommon cause of anemia. Classifications of AIHA include warm AIHA, cold AIHA (including mainly chronic cold agglutinin disease and paroxysmal cold hemoglobinuria), mixed-type AIHA and drug-induced AIHA. AIHA may also be further subdivided on the basis of etiology. Management of AIHA is based mainly on empirical data and on small, retrospective, uncontrolled studies. The therapeutic options for treating AIHA are increasing with monoclonal antibodies and, potentially, complement inhibitory drugs. Based on data available in the literature and our experience, we propose algorithms for the treatment of warm AIHA and cold agglutinin disease in adults. Therapeutic trials are needed in order to better stratify treatment, taking into account the promising efficacy of rituximab.
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Affiliation(s)
- Pascal Sève
- Department of Internal Medicine, Hôtel Dieu, 1 place de l'Hôpital, Lyon Cedex 02, France.
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Loustau V, Guillaud C, Garcon L, Godeau B, Michel M. [Hemolytic anemia in adults: Main causes and diagnostic procedure]. Presse Med 2011; 40:470-85. [PMID: 21295436 DOI: 10.1016/j.lpm.2010.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 11/03/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022] Open
Abstract
Hemolytic anemia (HA) is not an exceptional situation in adults. While establishing the hemolytic mechanism of an anemia is usually rather easy, finding the etiology may be quite difficult as both some hereditary (corpuscular) and acquired causes of HA may occur during adulthood. The diagnosis of HA therefore requires a multiple step procedure taking into account both patient's and family history, a careful analysis of the blood smear and a direct antiglobulin test. Based on these first data, the diagnosis procedure may then require more specific tests whose indications are discussed in this review.
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Affiliation(s)
- Valentine Loustau
- CHU Henri-Mondor, centre de référence pour les cytopénies auto-immunes de l'adulte, service de médecine interne, 94010 Créteil cedex, France
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Raffali J, Harmouche H, Benjilali L, Tazi-Mezalek Z, Adnaoui M, Aouni M, Maaouni A. [Autoimmune hemolytic anemia: An unusual revelation of human immunodeficiency virus]. Presse Med 2010; 39:840-2. [PMID: 20359860 DOI: 10.1016/j.lpm.2010.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 11/09/2009] [Accepted: 02/18/2010] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jihan Raffali
- Service de médecine interne, hôpital Ibn Sina, Rabat, Maroc.
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