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Yohannan B, Chan KH, Sridhar A, Idowu M. Warm autoimmune haemolytic anaemia seen in association with primary sclerosing cholangitis in the setting of Klebsiella pneumoniae bacteraemia. BMJ Case Rep 2022; 15:e248339. [PMID: 35606025 PMCID: PMC9174818 DOI: 10.1136/bcr-2021-248339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022] Open
Abstract
Warm autoimmune haemolytic anaemia mediated by warm agglutinins is a rare and heterogeneous disease which can be idiopathic or secondary to an underlying disease. Primary sclerosing cholangitis is a chronic autoimmune cholangiopathy that is very rarely associated with haemolytic anaemia. Infections can also act as triggers for immune haemolytic anaemia. Here, we report a case of a woman in her 50s with a history of primary sclerosing cholangitis and a positive direct antiglobulin test with no evidence of haemolysis who developed overt warm autoimmune haemolytic anaemia in the setting of cholangitis and Klebsiella pneumoniae bacteraemia. She was treated conservatively with appropriate antibiotics and cautious red blood cell transfusion with complete resolution of haemolysis; immunosuppression was avoided given sepsis on presentation. This case highlights a rare association of warm immune haemolytic anaemia in the setting of K. pneumoniae bacteraemia and the role of a tailored treatment approach to treat this heterogeneous disease.
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Affiliation(s)
- Binoy Yohannan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Kok Hoe Chan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Arthi Sridhar
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Modupe Idowu
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
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Cabo J, Brochier A, Saussoy P, van Dievoet MA, Capirchio L, Delire B, Deneys V. Positive direct antiglobulin test in COVID-19 patients: Decision-making process. Transfus Clin Biol 2021; 28:414-419. [PMID: 34111506 PMCID: PMC8183097 DOI: 10.1016/j.tracli.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 01/04/2023]
Abstract
In this unprecedented crisis of severe acute respiratory syndrome coronavirus 2 and its associated coronavirus disease 2019 (COVID-19), polymerase chain reaction and then serological testing platforms have been massively developed to face the important screening demand. Polymerase chain reaction and serological testing platforms are not the only actors impacted by the crisis, transfusion services are facing important difficulties. A positive direct antiglobulin test is frequently observed for patients encountering COVID-19. Patients with severe symptoms may develop anaemia and become good candidates for blood transfusions. The interpretation of a positive direct antiglobulin test for patients recently transfused and suffering from COVID-19 is complex. The differentiation between COVID-19 induced antibodies and possible associated transfusion alloantibodies is therefore crucial. In this context, the elution technique incorporated in an appropriate decision-making process plays its full role. This intricate topic is presented through a case report followed by literature review and finally decision-making process for COVID-19 patients necessitating red blood cells administration.
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Affiliation(s)
- J Cabo
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - A Brochier
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - P Saussoy
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - M-A van Dievoet
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - L Capirchio
- Gastroenterology department, Cliniques Universitaires St Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - B Delire
- Gastroenterology department, Cliniques Universitaires St Luc, Université catholique de Louvain, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
| | - V Deneys
- Clinical Biology Department, Cliniques Universitaires St Luc, Université catholique de Louvain, Banque de sang, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Brussels, Belgium.
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Bowen L, LePage N, Lewandowska M, Waxman DA. Anti-Pr antibody induced cold autoimmune hemolytic anemia following pneumococcal vaccination. Clin Case Rep 2019; 7:1763-1765. [PMID: 31534744 PMCID: PMC6745373 DOI: 10.1002/ccr3.2365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 11/29/2022] Open
Abstract
While rare, vaccination-induced autoantibodies can occur outside of the pediatric population. This diagnosis should be considered after infectious and lymphoproliferative disorders are ruled out. Clinical management will depend on the individual case, but all patients should be monitored closely.
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Affiliation(s)
- Laurel Bowen
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisINUSA
| | - Nichole LePage
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisINUSA
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Wilen CB, Booth GS, Grossman BJ, Lane WJ, Szklarski PC, Jackups R. Using direct antiglobulin test results to reduce unnecessary cold agglutinin testing. Transfusion 2017; 57:1480-1484. [DOI: 10.1111/trf.14059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 01/06/2017] [Accepted: 01/14/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Craig B. Wilen
- Department of Pathology and Immunology; Washington University School of Medicine; St Louis Missouri
| | - Garrett S. Booth
- Department of Pathology; Vanderbilt University Medical Center; Nashville Tennessee
| | - Brenda J. Grossman
- Department of Pathology and Immunology; Washington University School of Medicine; St Louis Missouri
| | - William J. Lane
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Penny C. Szklarski
- Department of Pathology; Vanderbilt University Medical Center; Nashville Tennessee
| | - Ronald Jackups
- Department of Pathology and Immunology; Washington University School of Medicine; St Louis Missouri
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Fadeyi EA, Simmons JH, Jones MR, Palavecino EL, Pomper GJ. Fatal Autoimmune Hemolytic Anemia Due to Immunoglobulin G Autoantibody Exacerbated by Epstein-Barr Virus. Lab Med 2015; 46:55-9. [DOI: 10.1309/lm9owrf64ogqodea] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Affiliation(s)
- Deepti Kulkarni
- Flat no. 203, Tarun apartment, Kalamboli, Navi Mumbai, India
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Brain M, Ruether B, Valentine K, Brown C, ter Keurs H. Life-threatening hemolytic anemia due to an autoanti-Pr cold agglutinin: evidence that glycophorin A antibodies may induce lipid bilayer exposure and cation permeability independent of agglutination. Transfusion 2010; 50:292-301. [DOI: 10.1111/j.1537-2995.2009.02445.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martí S, Grifols JR, Santesmases J, Benítez RM. [Cold agglutinin disease and pneumococal pneumonia]. Med Clin (Barc) 2009; 133:646-7. [PMID: 19261310 DOI: 10.1016/j.medcli.2008.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 11/24/2008] [Indexed: 10/20/2022]
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Valent P, Lechner K. Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review. Wien Klin Wochenschr 2008; 120:136-51. [DOI: 10.1007/s00508-008-0945-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 02/18/2008] [Indexed: 11/30/2022]
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Abstract
A 4-yr-old boy developed autoimmune hemolytic anemia after rubella infection and clinical manifestations cleared up after decrease in rubella specific IgM titer without any specific therapy.
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Affiliation(s)
- Neerja Agrawal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Vaglio S, Arista MC, Perrone MP, Tomei G, Testi AM, Coluzzi S, Girelli G. Autoimmune hemolytic anemia in childhood: serologic features in 100 cases. Transfusion 2007; 47:50-4. [PMID: 17207229 DOI: 10.1111/j.1537-2995.2007.01062.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Red blood cell (RBC) autoimmunization is a relatively uncommon cause of anemia in children and presents some differences from those of adults. Due to its frequency, autoimmune hemolytic anemia (AIHA) in childhood has prompted very few studies, and the literature consists mostly of sporadic case histories. The objective of this study was to stress the importance of an appropriate serologic diagnosis in suspected cases. STUDY DESIGN AND METHODS This report describes the immunohematologic features of 100 patients with AIHA studied in the Immunohaematologic Unit of Blood Bank, "La Sapienza" University of Rome. The patients were diagnosed in the same department from 1983 to 2003. RESULTS The peak incidence of AIHA was in the first 4 years of life. No sex predominance was noted. Warm AIHA was the most common type of acquired immune hemolytic anemia; it comprised 64 of the 100 patients, whereas 26 patients showed a cold AIHA. Associated AIHA showed a slightly more frequent incidence (54/100) compared to idiopathic forms of AIHA (46/100). CONCLUSIONS In this study serologic records of 100 children with confirmed AIHA are reported. This series, much larger than any previously reported, is critically reviewed and analyzed to delineate the immunologic features of the disease in childhood.
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Affiliation(s)
- Stefania Vaglio
- Blood Bank, "La Sapienza" University-II Faculty of Medicine, Rome, Italy.
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Hofer M, Weber A, Haffner K, Berlis A, Klingel K, Krüger M, Kandolf R, Volk B. Acute hemorrhagic leukoencephalitis (Hurst's disease) linked to Epstein-Barr virus infection. Acta Neuropathol 2005; 109:226-30. [PMID: 15791481 DOI: 10.1007/s00401-004-0930-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Revised: 09/08/2004] [Accepted: 09/09/2004] [Indexed: 10/26/2022]
Abstract
A 16-year-old girl presented signs of a common cold in combination with a hemolytic crisis. Within 3 days, she developed reduced consciousness and hemiparesis subsequently followed by coma. CT and MRI scans revealed evidence for raised intracranial pressure and an extensive inflammatory process extending from the brain stem up to the thalamus. The patient died within 3 weeks after onset of first symptoms of intracranial pressure despite maximum intensive care. Neuropathological examination revealed disseminated necrotic lesions and perivascular hemorrhages characteristic for acute hemorrhagic leukoencephalitis (Hurst's disease), mainly of the brain stem, diencephalon and cerebellum. Serological results, in situ hybridization and PCR analysis demonstrated an acute Epstein-Barr virus (EBV) infection of the central nervous system. To our knowledge, this is the first reported case of Hurst's disease linked to EBV.
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Affiliation(s)
- Markus Hofer
- Department of Neuropathology, Institute for Pathology, University Hospital Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany,
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Chandesris MO, Schleinitz N, Ferrera V, Bernit E, Mazodier K, Gayet S, Chiaroni JM, Veit V, Kaplanski G, Harlé JR. Agglutinines froides, circonstances de découverte chez l’adulte et signification en pratique clinique : analyse rétrospective à propos de 58 patients. Rev Med Interne 2004; 25:856-65. [PMID: 15582165 DOI: 10.1016/j.revmed.2004.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 08/20/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe clinical, biological characteristics and associated diseases of cold agglutinins in adults. METHODS Retrospective study in a single department of internal medicine from 1997 to 2002. The inclusion criteria were a positive direct Coombs test and a positive research for cold-reactive autoantibodies. We recorded for each patient: clinical presentation at onset and during follow-up, biological parameters of haemolysis, biological characteristics of the cold agglutinin and associated diseases. RESULTS Fifty-eight patients (34 females, 24 males), with medium age of 58.8 were included in the study. Clinical presentation was highly variable between acute life-threatening haemolysis and absence of symptoms. Results of direct antiglobulin test were C3 (74%), IgG + C3 (22.4%), IgG (3.4%). Titer, thermal amplitude, strength and specificity of Coombs test were correlated, in all cases except 6, with cold agglutinin haemolytic activity. In 77.6% of cases cold agglutinin was secondary; related to: autoimmune disorders (n = 19), lymphoproliferative disorders (n = 11) and infections (n = 10). CONCLUSION Clinical presentation of cold agglutinin is highly variable and not always related to the biological characteristics of the bound antibody (titer, thermal amplitude, specificity). In our single center study, diseases associated with cold agglutinin were various with the highest frequency of auto-immune disorders. Our study underlined also the high frequency of lymphoproliferative disorders and justifies a close follow-up of these patients. Finally, we reported a high frequency of hepatitis C virus infection among the infectious aetiologies.
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Affiliation(s)
- M-O Chandesris
- Service de médecine interne, hôpital de la conception, CHU, 14, boulevard Baille, 13385 Marseille cedex 05, France
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Arndt PA, Do JB, Garratty G, Kuriyan MA, Strair RK, Baranwal A. A high-titer, high-thermal-amplitude autoanti-B associated with acrocyanosis but no obvious hemolytic anemia. Transfusion 2003; 43:1133-7. [PMID: 12869121 DOI: 10.1046/j.1537-2995.2003.00453.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND ABO autoantibodies are rare. Most reported examples have been antibodies with 4 degrees C titers not greater than 256 in patients without apparent hemolytic anemia. Most high-titer, high-thermal-amplitude, complement-activating cold agglutinins are associated with hemolytic anemia. STUDY DESIGN AND METHODS A 52-year-old man presented with acrocyanosis and mild small-vessel brain disease, but no evidence of obvious hemolytic anemia. Regular plasmapheresis treatment was helpful in relieving the clinical symptoms associated with acrocyanosis. Serologic methods were used to study the patient's RBCs and sera. RESULTS The patient's RBCs were strongly reactive with anti-C3 and anti-IgM and weakly reactive with anti-IgA. The patient's serum contained a high-titer, high-thermal-amplitude, IgMkappa autoanti-B, capable of activating complement in vitro. CONCLUSION A patient with a powerful ABO autoantibody is described. This patient had acrocyanosis but did not appear to have an obvious hemolytic anemia. This case is a good example of the lack of correlation between in vitro serologic tests and in vivo reactions in individual patients.
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Affiliation(s)
- Patricia A Arndt
- American Red Cross Blood Services, Southern California Region, Los Angeles, California, USA.
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