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Browne T, Dearman RJ, Poles A. Human neutrophil antigens: Nature, clinical significance and detection. Int J Immunogenet 2020; 48:145-156. [PMID: 32970372 DOI: 10.1111/iji.12514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
Granulocytes are an essential part of both the innate and adaptive immune systems. Human neutrophil antigens (HNAs) are a family of epitopes that are located on glycoproteins that are mostly expressed on human granulocytes. Antibodies that recognize these epitopes have been associated with neutropenia, transfusion complications, haematopoietic stem cell transplant nonengraftment and renal transplant rejection. Currently, there are fourteen recognized HNA alleles across five antigen systems (HNA-1 through HNA-5), the molecular basis of which are located on the genes FCGR3B, CD177, SLC44A2, ITGAM and ITGAL, respectively. Elucidation of the associated genes has permitted the development of testing strategies for HNA typing and aided understanding of the associated epitopes. This review will outline the associated clinical conditions that require HNA investigation and how these are performed in specialized laboratories. Investigations provided are both reactive for patients with a variety of existing or suspected neutropenias and proactive in the testing of blood component donors in order to reduce the potential risk to patients who require transfusion.
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Affiliation(s)
- Tom Browne
- Histocompatibility and Immunogenetics Laboratory, NHS Blood and Transplant, Filton, Bristol, UK
| | - Rebecca J Dearman
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anthony Poles
- Histocompatibility and Immunogenetics Laboratory, NHS Blood and Transplant, Filton, Bristol, UK
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Win N, Massey E, Lucas G, Sage D, Brown C, Green A, Contreras M, Navarrete C. Ninety-six suspected transfusion related acute lung injury cases: Investigation findings and clinical outcome. Hematology 2013; 12:461-9. [PMID: 17852461 DOI: 10.1080/10245330701562345] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Transfusion related acute lung injury (TRALI) is one of the complications of blood transfusion and can result in major morbidity or mortality. The diagnosis depends upon the application of strict clinical criteria defining acute lung injury (ALI) and a temporal relationship to blood transfusion. We present the clinical and immunogenetic findings of 96 suspected TRALI cases investigated between 1996 and 2004. During this time period the national haemovigilance scheme (UK) defined TRALI as a reaction occurring either during or within 24 h of blood transfusion. Using clinical, laboratory and post mortem evidence, 64/96 cases could be defined as TRALI in our series. Sensitive techniques were employed to screen for HLA class I, class II and granulocyte specific antibodies in donor serum. Donor derived antibodies were detected in 58/64 (90%) of cases. Recipient derived DNA or cells were not always available but incompatibility was confirmed by the presence of the cognate antigen on recipient leucocytes or by crossmatching in 47/64 (73%) of cases. Cases referred prior to 2001 were not tested for HLA class II antibodies. By applying strict clinical criteria and using sensitive techniques a white blood cell antibody mediated immunological pathophysiology can be implicated in the majority TRALI cases.
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Affiliation(s)
- Nay Win
- Red Cell Immunohaematology, National Health Service Blood and Transplant (NHSBT), Tooting Centre, London, UK.
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Lucas G, Porcelijn L, Fung YL, Green F, Reil A, Hopkins M, Schuller R, Green A, de Haas M, Bux J. External quality assessment of human neutrophil antigen (HNA)-specific antibody detection and HNA genotyping from 2000 to 2012. Vox Sang 2013; 105:259-69. [PMID: 23663230 DOI: 10.1111/vox.12041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/14/2013] [Accepted: 03/19/2013] [Indexed: 11/30/2022]
Abstract
Since 2000, Quality Assurance (QA) exercises for the detection and identification of granulocyte antibodies and DNA typing for human neutrophil antigens (HNA) have been distributed within the International Granulocyte Immunobiology Workshops, which are linked to International Society of Blood Transfusion. The exercises were standardised at the outset to enable laboratory performance to be monitored. Between 2000 and 2012, nine exercises were distributed to 20 laboratories. Overall, 45 examples of 42 unique samples containing defined granulocyte reactive antibodies were distributed for serological analysis together with 20 samples for HNA genotyping. The level of satisfactory serological performance was initially set at 50% and later increased to 70%, while the 'cut-off' for HNA genotyping was set at 100% after 2008. Failure to achieve the minimum score in the QA exercises in consecutive years resulted in temporary exclusion. In 2000, the 15 participating laboratories had a mean score of 56.1% for serological analysis and 13 laboratories attempted HNA-1a and -1b genotyping, while 11 attempted HNA-1c typing. Steady improvements in proficiency for serological testing and HNA typing occurred in subsequent exercises. In 2012, the mean score for serology was 88.5% and 12/13 laboratories scored 100% for HNA-1a, -1b, -1c, -3a, -3b, -4a, -4bw, -5a and -5bw genotyping. These QA exercises have provided an invaluable tool to monitor and improve the standard of granulocyte immunology investigations for participating laboratories, thereby enhancing performance for both clinical investigations and donor screening programmes to reduce the incidence of TRALI.
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Affiliation(s)
- G Lucas
- Histocompatibility and Immunogenetics, NHS Blood and Transplant, Bristol, UK
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Metcalfe P, Rigsby P, Pearson H, Lucas G. An International reference reagent for the detection of anti-human neutrophil antigen-1a. Vox Sang 2012; 104:153-8. [PMID: 22998424 DOI: 10.1111/j.1423-0410.2012.01647.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Testing for neutrophil antibodies has become more common as awareness of transfusion-related acute lung injury (TRALI) has increased. However, unlike other areas of blood cell antibody testing, there are no certified reference reagents available with which laboratories can determine the sensitivity of detection of their assays. This report describes the production and evaluation of a freeze-dried preparation of human plasma, code 09/284, containing anti-human neutrophil antigen-1a (anti-HNA-1a) for use as a minimum sensitivity reagent. MATERIALS AND METHODS One-millilitre of aliquots of plasma containing anti-HNA-1a were freeze-dried in glass ampoules. To characterize the material, 24 laboratories took part in an international collaborative study. The participants evaluated doubling dilutions of the material using their in-house routine assays and recorded the highest dilution in which the antibody could be detected. RESULTS When diluted 1 in 4, most laboratories were able to detect the anti-HNA-1a in the material, and the participants agreed that this was an appropriate level to set as the minimum sensitivity required. CONCLUSIONS In October 2011, the WHO Expert Committee on Biological Standardization approved the material 09/284 as an International Reference Reagent for the detection of anti-HNA-1a.
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Affiliation(s)
- P Metcalfe
- Biotherapeutics Group, National Institute for Biological Standards and Control, Potters Bar, UK.
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Massey E, Harding K, Kahan BC, Llewelyn C, Wynn R, Moppett J, Robinson SP, Green A, Lucas G, Sadani D, Liakopoulou E, Bolton-Maggs P, Marks DI, Stanworth S. The granulocytes in neutropenia 1 (GIN 1) study: a safety study of granulocytes collected from whole blood and stored in additive solution and plasma. Transfus Med 2012; 22:277-84. [PMID: 22591484 DOI: 10.1111/j.1365-3148.2012.01152.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE/AIM To evaluate the safety of transfusing pooled, whole blood-derived granulocytes in additive solution and plasma (GASP) in 30 recipients. BACKGROUND Demand for granulocytes in England has increased five-fold. With the advantages of reduced red cell, plasma and overall volume, GASP maintains function in vitro. METHODS AND MATERIALS Observations were recorded prior to and post transfusion. Increments were recorded at 1 h and the following morning. Leucocyte antibody screening was undertaken prior to and at 1-6 months following transfusion. RESULTS Thirty patients aged between 8 months and 68 years received 221 GASP in 148 transfusion episodes. GASP contained an average of 1.0 × 10(10) granulocytes in 207 mL. Adults usually received two packs and children 10-20 mL kg(-1). Children and adults received a median [interquartile range (IQR)] dose of 12.5 (9.1-25.3) and 19.7 (12.0-25.8) × 10(9) granulocytes per transfusion, respectively. There was one episode of transfusion-associated circulatory overload (TACO) in a patient with chronic cardiac failure following 600 mL of unpooled granulocytes, other fluids and one GASP. New leucocyte alloimmunisation occurred in 3/30 recipients 10%. No other significant reactions were reported. Median peripheral blood neutrophil increments at 1 h post transfusion were 0.06 (IQR, 0.01-0.17) in children and (0.03) (IQR, 0-0.16) in adults. CONCLUSION GASP has a similar safety profile to other sources of granulocytes for patients with refractory infection or in need of secondary prophylactic transfusion. Further studies are required to clarify the role of GASP in the treatment of neutropenic patients.
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Affiliation(s)
- Edwin Massey
- NHS Blood and Transplant, North Bristol Park, Northway Filton, Bristol BS34 7QH, UK.
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Lucas G, Win N, Calvert A, Green A, Griffin E, Bendukidze N, Hopkins M, Browne T, Poles A, Chapman C, Massey E. Reducing the incidence of TRALI in the UK: the results of screening for donor leucocyte antibodies and the development of national guidelines. Vox Sang 2011; 103:10-7. [DOI: 10.1111/j.1423-0410.2011.01570.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chapman CE, Stainsby D, Jones H, Love E, Massey E, Win N, Navarrete C, Lucas G, Soni N, Morgan C, Choo L, Cohen H, Williamson LM. Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion 2009; 49:440-52. [DOI: 10.1111/j.1537-2995.2008.01948.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Nishimura M, Mitsunaga S, Ishikawa Y, Satake M. Possible mechanisms underlying development of transfusion-related acute lung injury: roles of anti-major histocompatibility complex class II DR antibody. Transfus Med 2003; 13:141-7. [PMID: 12791081 DOI: 10.1046/j.1365-3148.2003.00434.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anti-major histocompatibility complex (anti-MHC) antibodies (Abs) and antipolymorphonuclear neutrophil (anti-PMN) Abs are generally considered as the main causes of the development of transfusion-related acute lung injury (TRALI), which is one of the most severe and sometimes lethal side effects of transfusion. These Abs are postulated to activate recipient's leucocytes, resulting in the release of soluble factors such as reactive oxygen species and detrimental cytokines and chemokines. The harmful effects on the lung tissues and resident leucocytes of these malignant factors are suspected to be profoundly involved in TRALI reactions. Several reports have indicated the principle effect of biologically active lipids on the pathogenesis of TRALI. However, the precise mechanisms of TRALI development remain unclear. To resolve this issue, we have been investigating cytokines that induce continuous inflammation of the lungs, specifically focusing on the cytokines derived from activated PMNs. We observed that the granulocyte-macrophage colony-stimulating factor (GM-CSF) markedly enhances the expression of MHC class II DR in PMNs. Moreover, MHC class II DR-expressing PMNs were also proved to express a high-affinity receptor for immunoglobulin E (IgE) (FcepsilonRI) and to produce tumour necrosis factor-alpha, interferon-gamma and interleukin-18 following a challenge with an anti-MHC class II DR monoclonal Ab (MoAb) or anti-DR antiserum. It is strongly suggested that amongst various inflammatory mediators, at least these three cytokines may contribute to the duration of inflammatory reactions in the lungs. Furthermore, FcepsilonRI expression, in GM-CSF-treated PMNs, suggests the involvement of PMNs in IgE-mediated immune reactions.
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Affiliation(s)
- M Nishimura
- Department of Research, Tokyo Metropolitan Red Cross Blood Center, Tokyo, Japan.
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Lucas G, Rogers S, de Haas M, Porcelijn L, Bux J. Report on the Fourth International Granulocyte Immunology Workshop: progress toward quality assessment. Transfusion 2002; 42:462-8. [PMID: 12076294 DOI: 10.1046/j.1525-1438.2002.00053.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A formal quality assurance (QA) scheme has been established to facilitate proficiency testing for granulocyte antibodies and antigens. STUDY DESIGN AND METHODS Fifteen laboratories participated in the Fourth International Granulocyte Immunology Workshop. The main objective of the workshop was to establish a formal QA scheme for granulocyte serology and molecular typing methods. A secondary objective was to determine the relative sensitivities of the granulocyte immunofluorescence test, granulocyte agglutination test, and MoAb immobilization assays using defined antisera and protocols. RESULTS Laboratories scored between 16.7 and 100 percent (mean, 57.5%) of the maximum available in the serologic part of this QA exercise. There were particular problems in detecting granulocyte-specific human neutrophil antigen-1 (HNA-1a) IgM antibodies and HNA-2a antibodies in the presence of HNA-1b antibodies. The granulocyte immunofluorescence test was more sensitive than the granulocyte agglutination test in titration studies, but the latter method more readily identified the presence of HNA-3a antibodies. HNA genotyping was generally well performed, with nine laboratories obtaining 100-percent correct results for HNA-1a, HNA-1b, and HNA-1c. CONCLUSIONS There is a need to standardize the detection of granulocyte-specific antibodies. Laboratories with good performance tended to use two methods for detecting granulocyte-specific antibodies and an HNA-typed panel of granulocytes. The use of a method for elucidating mixtures of granulocyte- and lymphocyte-reactive antibodies (e.g., MoAb immobilization assay) and the use of methods for detecting both cytotoxic and noncytotoxic HLA class I antibodies were also associated with a higher than average performance.
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Affiliation(s)
- Geoffrey Lucas
- International Blood Group Reference Laboratory, Bristol, UK.
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Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a rare condition that is commonly associated with the transfusion of donor plasma containing WBC antibodies. Biologically active lipids that accumulate during storage of RBCs and platelets may also cause TRALI. There has been only one previously reported case of recurrent TRALI. CASE REPORT A patient received a transfusion 2 days after undergoing hysterectomy; she developed TRALI after receiving the transfusion. The patient recovered after being on ventilation for 6 days but received an additional transfusion and had a second episode of TRALI, which required further ventilation. RESULTS Laboratory investigation of the first episode of TRALI suggested the presence of HLA-A2 (N = 1) and granulocyte-specific IgM antibodies (N = 2) in the sera from three of the donors. All three sera reacted in crossmatch studies with the patient's granulocytes and lymphocytes. Lymphocyte-specific IgG antibodies were detected in the patient's serum. There was no evidence to suggest the involvement of WBC antibodies in the second episode of TRALI. Antibody screening of the donors' samples and both forward and reverse crossmatch studies were negative. CONCLUSION The first episode of TRALI seems to be due to the action of HLA-A2 and granulocyte-specific IgM antibodies. The second episode may have been due to the action of lipid neutrophil-priming agents in the donors' units in association with the patient's underlying pulmonary condition (i.e., recovering from lung injury). TRALI can recur if a patient requires further transfusion support shortly after an initial episode of TRALI.
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Affiliation(s)
- N Win
- Department of Immunohaematology, National Blood Service, South Thames Centre, London, UK.
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Willis F, Marsh JC, Bevan DH, Killick SB, Lucas G, Griffiths R, Ouwehand W, Hale G, Waldmann H, Gordon-Smith EC. The effect of treatment with Campath-1H in patients with autoimmune cytopenias. Br J Haematol 2001; 114:891-8. [PMID: 11564082 DOI: 10.1046/j.1365-2141.2001.03039.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe 21 patients with severe and life-threatening autoimmune cytopenias resistant to standard immunosuppression who were treated with the monoclonal antibody Campath-1H. Four patients had autoimmune neutropenia, four had autoimmune haemolytic anaemia, four had pure red cell aplasia, one had immune thrombocytopenia purpura (ITP), three had autoimmune haemolytic anaemia and ITP (Evan's syndrome), three had autoimmune pancytopenia (ITP, autoimmune neutropenia and autoimmune haemolytic anaemia), one had ITP (associated with acquired Glanzmann's disease) and autoimmune neutropenia, and one had ITP and red cell aplasia. Campath-1H was administered at a dose of 10 mg/d as an intravenous infusion for 10 d. Responses were seen in 15 patients, which were sustained in six. Relapse occurred in eight patients after Campath-1H treatment. Patients entering the study later, received cyclosporine after Campath-1H in an attempt to reduce the incidence of relapse. Three patients received a second course of Campath-1H; all responded but later relapsed. Fourteen patients are alive at a median of 12 months (range 4-61) after Campath-1H. Campath-1H represents an alternative therapeutic option for severe, refractory autoimmune cytopenias.
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MESH Headings
- Adolescent
- Adult
- Aged
- Alemtuzumab
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents/therapeutic use
- Autoimmune Diseases/drug therapy
- Cyclosporine/therapeutic use
- Female
- Humans
- Immunosuppressive Agents/therapeutic use
- Male
- Middle Aged
- Neutropenia/drug therapy
- Neutropenia/immunology
- Pancytopenia/drug therapy
- Pancytopenia/immunology
- Pilot Projects
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Recurrence
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/immunology
- Treatment Outcome
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Affiliation(s)
- F Willis
- Department of Haematology, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK
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Palfi M, Berg S, Ernerudh J, Berlin G. A randomized controlled trial oftransfusion-related acute lung injury: is plasma from multiparous blood donors dangerous? Transfusion 2001; 41:317-22. [PMID: 11274583 DOI: 10.1046/j.1537-2995.2001.41030317.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) and other posttransfusion reactions may be caused by granulocyte and/or HLA antibodies, which are often present in blood from multiparous donors. The purpose of this study was to compare the effects of plasma from multiparous donors with those of plasma from donors with no history of transfusion or pregnancy (control plasma) in a prospective, randomized, double-blind, crossover study. STUDY DESIGN AND METHODS Intensive care patients, judged to need at least 2 units of plasma, were randomly assigned to receive a unit of control plasma and, 4 hours later, a plasma unit from a multiparous donor (> or = 3 live births) or to receive the plasma units in opposite order. The patients were closely monitored, and body temperature, blood pressure, and heart rate were recorded. Blood samples for analysis of blood gases, TNFalpha, IL-1 receptor antagonist, soluble E selectin, and C3d complement factor were collected at least on four occasions (before and after the transfusion of each unit). RESULTS Transfusion of plasma from multiparous donors was associated with significantly lower oxygen saturation and higher TNFalpha concentrations than transfusion of control plasma. The mean arterial pressure increased significantly after the transfusion of control plasma, whereas plasma from multiparous donors had no effect on it. Five posttransfusion reactions were observed in 100 patients, in four cases after the transfusion of plasma from multiparous donors. CONCLUSION Plasma from multiparous blood donors may impair pulmonary function in intensive care unit patients.
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Affiliation(s)
- M Palfi
- Department of Transfusion Medicine and Clinical Immunology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Lucas G, Rogers S, Evans R, Hambley H, Win N. Transfusion-Related Acute Lung Injury Associated with Interdonor Incompatibility for the Neutrophil-Specific Antigen HNA-1a. Vox Sang 2000. [DOI: 10.1046/j.1423-0410.2000.7920112.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hellmich B, Schnabel A, Gross WL. Treatment of severe neutropenia due to Felty's syndrome or systemic lupus erythematosus with granulocyte colony-stimulating factor. Semin Arthritis Rheum 1999; 29:82-99. [PMID: 10553980 DOI: 10.1016/s0049-0172(99)80040-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To examine the efficacy and safety of recombinant human granulocyte colony-stimulating factor (rhG-CSF) and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) for the treatment of severe neutropenia due to Felty's syndrome (FS) or systemic lupus erythematosus (SLE). METHODS Eight patients with absolute neutrophil counts (ANC) below 1,000/microL attributable to FS (n = 4) or SLE (n = 4) were treated with rhG-CSF. The hematologic and clinical response as well as side effects were recorded. In addition, reports on the use of rhG-CSF/rhGM-CSF in FS and SLE retrieved from the English language literature were analyzed. RESULTS RhG-CSF effectively corrected neutropenia due to FS and SLE in seven of the current eight patients. In 54 of 55 FS and SLE patients retrieved from the literature, G-CSF or GM-CSF, respectively, proved to be effective at elevating the neutrophil count, which was often associated with improvement of infectious complications. The neutrophil count often declined again when growth factor treatment was stopped but generally stabilized at a level that exceeded the pretreatment count. Side effects included rare cases of thrombocytopenia, arthralgias, and development of cutaneous leukocytoclastic vasculitis. Side effects were dose dependent and resolved when treatment was discontinued. One of our own patients and 17 previously reported patients continued to benefit from long-term administration of rhG-CSF over periods of more than 40 months. CONCLUSIONS RhG-CSF is an effective and generally well-tolerated treatment for neutropenia due to FS or SLE. Exacerbation of the underlying rheumatic condition due to G-CSF appears to be rare if G-CSF is administered at the lowest dose effective at elevating the ANC above 1,000/microL.
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Affiliation(s)
- B Hellmich
- Poliklinik für Rheumatologie, Medizinische Universität zu Lübeck, Germany
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15
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Abstract
Immune‐mediated neutropenia, also termed autoimmune neutropenia (AIN), is an uncommon event, rarely documented within veterinary literature, although the clinical profile and probable pathogenesis have been outlined in detail within medical literature. In this paper, we review 2 different manifestations of this disorder. The 1st case primarily involved peripheral destruction of mature neutrophils, with little impact on marrow precursors, whereas the 2nd case resulted in suppression of neutrophilic granulopoiesis within marrow. In both cases, absolute neutrophil counts dropped below 200/mL.
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Affiliation(s)
- P M McManus
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104, USA.
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16
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Stern SC, Shah S, Costello C. Probable autoimmune neutropenia induced by fludarabine treatment for chronic lymphocytic leukaemia. Br J Haematol 1999; 106:836-7. [PMID: 10469479 DOI: 10.1046/j.1365-2141.1999.01682.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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McManus PM, Litwin C, Barber L. Immune-mediated neutropenia in 2 dogs. J Vet Intern Med 1999; 13:372-4. [PMID: 10449230 PMCID: PMC7197575 DOI: 10.1892/0891-6640(1999)013<0372:imnid>2.3.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Immune‐mediated neutropenia, also termed autoimmune neutropenia (AIN), is an uncommon event, rarely documented within veterinary literature, although the clinical profile and probable pathogenesis have been outlined in detail within medical literature. In this paper, we review 2 different manifestations of this disorder. The 1st case primarily involved peripheral destruction of mature neutrophils, with little impact on marrow precursors, whereas the 2nd case resulted in suppression of neutrophilic granulopoiesis within marrow. In both cases, absolute neutrophil counts dropped below 200/mL.
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Affiliation(s)
- P M McManus
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104, USA.
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18
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Leach M, Vora AJ, Jones DA, Lucas G. Transfusion-related acute lung injury (TRALI) following autologous stem cell transplant for relapsed acute myeloid leukaemia: a case report and review of the literature. Transfus Med 1998; 8:333-7. [PMID: 9881428 DOI: 10.1046/j.1365-3148.1998.00165.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A fatal case of transfusion-related acute lung injury (TRALI) in a child post-autologous stem cell transplant for relapsed acute myeloid leukaemia is described. The implicated product was a single unit platelet concentrate containing anti-HLA A2 and granulocyte-specific anti-NA1 antibodies. The recipient typed as HLA A2/A2, NA1/NA1. This is the first reported case of TRALI following a transplant procedure for a haematological condition. It is also unusual in that the patient failed to make a full recovery and that two relevant leucocyte antibodies of clear specificity were identified in the donor plasma. The literature relating to the pathophysiology, clinical sequelae and management of TRALI is reviewed.
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Affiliation(s)
- M Leach
- Royal Hallamshire Hospital, Sheffield, UK
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19
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Bux J. Challenges in the determination of clinically significant granulocyte antibodies and antigens. Transfus Med Rev 1996; 10:222-32. [PMID: 8809971 DOI: 10.1016/s0887-7963(96)80061-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J Bux
- Institute for Clinical Immunology and Transfusion Medicine, Giessen, Germany
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McMullin MF, Finch MB. Felty's syndrome treated with rhG-CSF associated with flare of arthritis and skin rash. Clin Rheumatol 1995; 14:204-8. [PMID: 7540527 DOI: 10.1007/bf02214945] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient with Felty's syndrome and rheumatoid arthritis was treated with recombinant granulocyte stimulating factor rhG-CSF (Neupogen) in view of severe neutropenia. He had a prompt rise in his neutrophil count and associated with this a severe flare of his arthritis and a skin rash. rhG-CSF was stopped, his neutrophil count fell rapidly and his symptoms resolved. rhG-CSF and the resulting rise in neutrophil count may be associated with flare of autoimmune disease in susceptible individuals.
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von dem Borne AE, de Haas M, Roos D, Homburg CH, van der Schoot CE. Neutrophil antigens, from bench to bedside. Immunol Invest 1995; 24:245-72. [PMID: 7713586 DOI: 10.3109/08820139509062776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A E von dem Borne
- Department of Hematology, Academic Medical Centre, Amsterdam, The Netherlands
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