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Zhou Y, Ding YL, Zhang LJ, Peng M, Huang J. Direct antiglobulin test-negative autoimmune hemolytic anemia in a patient with β-thalassemia minor during pregnancy: A case report. World J Clin Cases 2022; 10:1388-1393. [PMID: 35211574 PMCID: PMC8855192 DOI: 10.12998/wjcc.v10.i4.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/27/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe refractory anemia during pregnancy can cause serious maternal and fetal complications. If the cause cannot be identified in time and accurately, blind symptomatic support treatment may cause serious economic burden. Thalassemia minor pregnancy is commonly considered uneventful, and the condition of anemia rarely progresses during pregnancy. Autoimmune hemolytic anemia (AIHA) is rare during pregnancy with no exact incidence available.
CASE SUMMARY We report the case of a 30-year-old β-thalassemia minor multiparous patient experiencing severe refractory anemia throughout pregnancy. We monitored the patient closely, carried out a full differential diagnosis, made a diagnosis of direct antiglobulin test-negative AIHA, and treated her with prednisone and intravenous immunoglobulin. The patient gave birth to a healthy full-term baby.
CONCLUSION Coombs-negative AIHA should be suspected in cases of severe hemolytic anemia in pregnant patients with and without other hematological diseases.
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Affiliation(s)
- Yang Zhou
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Yi-Ling Ding
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Li-Juan Zhang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Mei Peng
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Jian Huang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Maroto A, Martinez-Diago C, Tio G, Sagues M, Borrell A, Bonmati A, Teixidor M, Adrados C, Torrent S, Alvarez E. Autoimmune hemolytic anemia in pregnancy: a challenge for maternal and fetal follow-up. J Matern Fetal Neonatal Med 2020; 35:996-998. [PMID: 32098549 DOI: 10.1080/14767058.2020.1732344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Autoimmune hemolytic anemia (AIHA) is a rare entity during pregnancy. The fetal risk is determined primarily by the ability of autoantibodies to cross the placental barrier. Currently, the establishment of a standardized antenatal care in cases with AIHA remains as a pending issue.Cases: Firstly, we describe a case of a 17-week pregnant woman that was diagnosed with cold agglutinin mediated (C3 and IgM) AIHA. Treatment was started with prednisone, showing initial improvement, but requiring intravenous gammaglobulins at 27 weeks. During the fetal follow-up, all studies showed normal results. In the third trimester, when there was a clinic and analytic maternal improvement, an unexpected fetal death occurred. Secondly, we present a case of a 30-week pregnant woman, diagnosed with warm antibody (IgG) AIHA. Despite the ability of IgG to cross the placental barrier, the serial measurements of the Middle Cerebral Artery (MCA) peak systolic velocity were always normal and childbirth occurred at term without any adverse perinatal outcome.Conclusion: During pregnancy, identification of the type antibodies in AIHA is crucial to estimate the potential maternal and fetal risks and to establish the follow-up. The interaction of the complement cascade with the coagulation cascade could be an explanation for a perinatal adverse outcome despite the inability of the IgM to cross the placental barrier.
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Affiliation(s)
- Anna Maroto
- Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | | | - Gisela Tio
- Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | | | - Ana Borrell
- Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | | | - Mireia Teixidor
- Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Cristina Adrados
- Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Sara Torrent
- Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Elena Alvarez
- Doctor Josep Trueta University Hospital of Girona, Girona, Spain
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Lunge S, Patil V, Doshi B. Cardiac side effect of rituximab. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2020. [DOI: 10.4103/ijdd.ijdd_64_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Passalia C, Minetto P, Arboscello E, Balleari E, Bellodi A, Del Corso L, Molinari E, Ponassi I, Oneto C, Sicbaldi V, Ghio R. Cardiovascular Adverse Events Complicating the Administration of Rituximab: Report of Two Cases. TUMORI JOURNAL 2018. [DOI: 10.1177/030089161309900622] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Rituximab is a murine/human chimeric monoclonal antibody directed against the CD20 antigen. It is widely used in combination with polychemotherapy regimens for the treatment of hematological disorders. There is no evidence of direct cardiotoxicity of the drug but a few cases of cardiovascular adverse events have been reported in the literature. We report on two patients affected by stage IV non-Hodgkin lymphoma with bone marrow infiltration and peripheral blood involvement who experienced cardiovascular accidents temporally related to rituximab infusion. In both cases the monoclonal antibody was administered in association with a polychemotherapy regimen but administration was postponed several days later in order to avoid severe cytokine release syndrome because of the high tumor burden. The first case concerns an episode of atrial fibrillation in a patient with a diagnosis of small B-cell lymphoma. The episode happened immediately after rituximab infusion. In the second case there was an episode of chest pain associated with fever and chills during rituximab infusion in a patient with a diagnosis of mantle cell lymphoma. In both cases we noticed an unusual correlation between symptom recurrence and the speed of rituximab infusion. Both patients presented several cardiovascular risk factors but preliminary cardiac function assessment excluded signs of heart dysfunction. The pathogenesis of cardiovascular events during rituximab infusion remains unclear. A key role might be played by cytokine release from B cells as a consequence of rituximab activity. Moreover, pre-existing silent cardiac damage could be co-responsible for the clinical manifestations we reported. We consider our clinical experience relevant because it raises an issue of good clinical practice: despite rituximab's good tolerability profile, patients with cardiovascular risk factors should undergo accurate cardiac assessment so that silent heart disease can be detected. If the suspicion of cardiac damage is high, more extensive cardiac assessment is recommended.
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Affiliation(s)
- Caterina Passalia
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Paola Minetto
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Eleonora Arboscello
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Enrico Balleari
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Andrea Bellodi
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Lisette Del Corso
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Elisa Molinari
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Irene Ponassi
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Caterina Oneto
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Vera Sicbaldi
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
| | - Riccardo Ghio
- Internal Medicine Unit 3, Department of Hemato-Oncology, IRCCS AOU San Martino, IST, National Institute for Cancer Research, Genoa, Italy
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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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Cheungpasitporn W, Kopecky SL, Specks U, Bharucha K, Fervenza FC. Non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy. J Renal Inj Prev 2016; 6:18-25. [PMID: 28487867 PMCID: PMC5414514 DOI: 10.15171/jrip.2017.04] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/14/2016] [Indexed: 01/08/2023] Open
Abstract
Rituximab is an anti-CD20 monoclonal antibody frequently used for the treatment of non-Hodgkin's lymphoma, chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), and anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis. In addition, rituximab has recently been increasingly used as an off-label treatment in a number of inflammatory and systemic autoimmune diseases. It is advised that rituximab infusion may cause infusion reactions and adverse cardiac effects including arrhythmia and angina, especially in patients with prior history of cardiovascular diseases. However, its detailed cardiotoxicity profile and effects on cardiac function were not well described. We report a 51-year-old man who developed non-ischemic cardiomyopathy after rituximab treatment for membranous nephropathy. The patient experienced reduced cardiac functions within 48 hours after the initial infusion, which remained markedly reduced at 9-month follow-up. As the utility of rituximab expands, physicians must be aware of this serious cardiovascular adverse effect.
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Affiliation(s)
- Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ulrich Specks
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kharmen Bharucha
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fernando C Fervenza
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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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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Hosoba S, Jaye DL, Cohen C, Roback JD, Waller EK. Successful treatment of severe immune hemolytic anemia after allogeneic stem cell transplantation with bortezomib: report of a case and review of literature. Transfusion 2014; 55:259-64. [PMID: 25156334 PMCID: PMC4342762 DOI: 10.1111/trf.12815] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/22/2014] [Accepted: 06/26/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immune hemolytic anemia is a well-known complication after allogeneic hematopoietic stem cell transplantation (HSCT). Posttransplant hemolytic anemia results in increased red blood cell transfusions and medical sequelae including iron overload. CASE REPORT We present a case report of immune hemolytic anemia that occurred after allogeneic HSCT from an ABO major-mismatched, HLA-matched unrelated donor. The patient had high anti-donor A type antibodies that were unresponsive to treatment with steroids and rituximab, resulting in persistent transfusion dependence. A detailed time course of anti-A titers, plasma cell content of the marrow, and B-cell content of the blood is presented. Treatment with bortezomib, a protease inhibitor, eliminated residual host-type plasma cells secreting anti-A and restored normal donor-derived erythropoiesis. CONCLUSION This report, and a review of literature for treatment of immune hemolytic anemia after allogeneic HSCT, supports the utility of bortezomib as plasma cell-targeted therapy in this setting.
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Affiliation(s)
- Sakura Hosoba
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
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