1
|
Primary IgA-mediated Autoimmune Hemolytic Anemia in an Infant Successfully Treated With Rituximab. J Pediatr Hematol Oncol 2020; 42:e615-e619. [PMID: 32118812 DOI: 10.1097/mph.0000000000001765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Autoimmune hemolytic anemia (AIHA) is uncommon in the pediatric population and is often associated with an infectious etiology or postvaccination. Mostly, the child presents with a positive direct antiglobulin test. The diagnosis can be challenging, as in our case with an immunoglobulin A-mediated AIHA. In addition to supportive therapy, such as a red blood cell transfusion, steroids are the first choice of treatment. Rituximab, as second-line treatment, can be given in conjunction. We report the first case of immunoglobulin A-mediated AIHA treated with rituximab in the literature.
Collapse
|
2
|
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.
Collapse
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
| | | | | |
Collapse
|
3
|
Hsieh YL, Lin LH. Thrombocytopenic purpura following vaccination in early childhood: experience of a medical center in the past 2 decades. J Chin Med Assoc 2010; 73:634-7. [PMID: 21145511 DOI: 10.1016/s1726-4901(10)70138-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/14/2010] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The etiology of thrombocytopenia during infancy and early childhood may be different from that of older children, because young children frequently receive vaccines. The following study was performed to understand whether there was a causal relationship between vaccinations and thrombocytopenia. METHODS We retrospectively studied, through chart review, the relationship between vaccination and thrombocytopenic purpura in 20 children with thrombocytopenia (platelet count < 150 x 10³/mm³) under the age of 3 years who were hospitalized between 1989 and 2010. Cases with a history of infectious symptoms/signs between vaccination and the occurrence of thrombocytopenia were excluded. Thrombocytopenia cases not diagnosed as idiopathic thrombocytopenic purpura but as post-vaccination thrombocytopenic purpura should have a similar vaccination-to-thrombocytopenia interval as reported in Western journals, but which should not be more than 9 weeks after vaccination. RESULTS Of the 20 cases of thrombocytopenic purpura, 12 followed vaccination and 8 were considered idiopathic. Of the 12 post-vaccination cases, 5 occurred after the second dose of hepatitis B virus vaccine at 1 month of age, 4 occurred after the first dose of diphtheria-tetanus-acellular pertussis-containing vaccine at 2-3 months of age, 2 occurred after the first dose of measles-mumps-rubella vaccine at 16 months of age, and 1 occurred after the first dose of varicella vaccine at 14 months of age. One of these 12 cases, who also had a marked decrease in hemoglobin level without bleeding, was suspected to have Evans syndrome. CONCLUSION Vaccination may be a risk factor for infant thrombocytopenic purpura.
Collapse
Affiliation(s)
- Yuh-Lin Hsieh
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan, R.O.C
| | | |
Collapse
|
4
|
Naleway AL, Belongia EA, Donahue JG, Kieke BA, Glanz JM. Risk of immune hemolytic anemia in children following immunization. Vaccine 2009; 27:7394-7. [PMID: 19766577 DOI: 10.1016/j.vaccine.2009.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/04/2009] [Accepted: 09/04/2009] [Indexed: 10/20/2022]
Abstract
Several case reports have described immune hemolytic anemia (IHA) following vaccination in children. We examined the risk of IHA in the 42 days following vaccination exposure using a self-controlled case series study design. In our population-based cohort of nearly 4.5 million children in the Vaccine Safety Datalink, we identified 55 confirmed cases of new-onset IHA from 1991 through 2000. We found no association between IHA and diphtheria-pertussis-tetanus vaccination (incidence rate ratio (IRR)=0.65, 95% CI: 0.19-2.24), hepatitis B vaccination (IRR=1.73, 95% CI: 0.59-5.01), or any vaccination (IRR=1.04, 95% CI: 0.46-2.32).
Collapse
Affiliation(s)
- Allison L Naleway
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, United States.
| | | | | | | | | | | |
Collapse
|
5
|
Yeruham I, Avidar Y, Harrus S, Fishman L, Aroch I. Immune-mediated thrombocytopenia and putative haemolytic anaemia associated with a polyvalent botulism vaccination in a cow. Vet Rec 2003; 153:502-4. [PMID: 14601798 DOI: 10.1136/vr.153.16.502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- I Yeruham
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, PO Box 12, Rehovot 76100, Israel
| | | | | | | | | |
Collapse
|
6
|
Johnson ST, McFarland JG, Kelly KJ, Casper JT, Gottschall JL. Transfusion support with RBCs from an Mk homozygote in a case of autoimmune hemolytic anemia following diphtheria-pertussis-tetanus vaccination. Transfusion 2002; 42:567-71. [PMID: 12084164 DOI: 10.1046/j.1537-2995.2002.00093.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Autoimmune hemolytic anemia (AIHA) in children, although unusual, is often associated with recent infection. Several reports have identified the diphtheria-pertussis-tetanus (DPT) vaccination as a possible trigger for AIHA. STUDY DESIGN AND METHODS Life-threatening AIHA was diagnosed in a 6-week-old infant 5 days after receiving a DPT vaccination. The patient required daily transfusion and/or exchange transfusion for 3 weeks. RBCs from an Mk homozygote were found compatible with the patient's autoantibody. Transfusion of RBCs from an Mk homozygote and later RBCs from an individual (K.T.) with a variant glycophorin, Mi.VII, were required to sustain the patient's Hb level until autoantibody production ceased, as evidenced by a fall in antibody titer and the patient's Hct returning to normal. RESULTS The DAT was positive (3+) with only anti-C3 on presentation. An IgM cold reactive autoantibody with probable anti-Pr specificity and high thermal amplitude (37 degrees C) was identified in the serum. The DAT was no longer positive after transfusion with compatible blood. CONCLUSION This case represents life-threatening AIHA in an infant, temporally related to a DPT injection and responsive to a combination of immunosuppression and transfusion of rare compatible blood.
Collapse
Affiliation(s)
- Susan T Johnson
- Immunohematology Reference Laboratory, The Blood Center of Southeastern Wisconsin, Children's Hospital of Wisconsin, and the Medical College of Wisconsin, Milwaukee, Wisconsin 53201-2178, USA
| | | | | | | | | |
Collapse
|
7
|
Classen JB, Classen DC. Vaccines and the risk of insulin-dependent diabetes (IDDM): potential mechanism of action. Med Hypotheses 2001; 57:532-8. [PMID: 11735306 DOI: 10.1054/mehy.2001.1352] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Immunization with a number of different vaccines, including live and killed vaccines, has been linked to the development of insulin-dependent (type 1) diabetes in humans and animals. Multiple different mechanisms have been proposed to explain the association between vaccines and diabetes. The current paper reviews multiple different mechanisms by which vaccines are known to manipulate the immune system and can induce an autoimmune disease such as type 1 diabetes. Genetic variability may determine which of these pathways, or possible other pathways, predominate in an individual following immunization.
Collapse
Affiliation(s)
- J B Classen
- Classen Immunotherapies Inc., 6517 Montrose Avenue, Baltimore, MD 21212, USA.
| | | |
Collapse
|
8
|
Downes KA, Domen RE, McCarron KF, Bringelsen KA. Acute autoimmune hemolytic anemia following DTP vaccination: report of a fatal case and review of the literature. Clin Pediatr (Phila) 2001; 40:355-8. [PMID: 11824181 DOI: 10.1177/000992280104000610] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- K A Downes
- Department of Clinical Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | |
Collapse
|
9
|
Abstract
BACKGROUND Two children in whom acute autoimmune hemolytic anemia (AIHA) developed after vaccination were studied. CASE REPORTS The children were a 20-month-old girl and a 21-month-old boy. The diagnosis of AIHA was made in accordance with established criteria (hemolysis, positive DAT, and lack of other reasons for the hemolysis). Serologic tests were performed according to standard technique. RESULTS The girl experienced two attacks of hemolysis. The first episode occurred 2 weeks after oral polio vaccination, and the second episode was observed 7 months later, when she received a simultaneous vaccination against mumps, rubella, and measles. The DAT was strongly positive with anti-C3d. No autoantibodies were detectable in either episode. The boy experienced acute hemolysis a few days after a simultaneous revaccination against diphtheria-pertussis-tetanus, Haemophilus influenzae, hepatitis B, and polio. The DAT using anti-IgG was strongly positive, and the DAT performed with anti-C3d was weakly positive. CONCLUSION Vaccination-induced AIHA resembles those forms of AIHA related to infectious diseases, and it may occur more frequently than has been reported.
Collapse
Affiliation(s)
- A Seltsam
- Blood Bank and Division of Hematology/Oncology, Department of Internal Medicine, Charité University Hospital/Virchow Clinic, Humboldt University, Berlin, Germany
| | | | | |
Collapse
|
10
|
Abstract
Vaccination has been incriminated as a trigger of immune-mediated hemolytic anemia (IMHA) in dogs and in people, but evidence to support this association is lacking. In a controlled retrospective study, idiopathic IMHA was identified in 58 dogs over a 27-month period. When compared with a randomly selected control group of 70 dogs (presented for reasons other than IMHA) over the same period, the distribution of cases versus time since vaccination was different (P < .05). Fifteen of the dogs (26%) had been vaccinated within 1 month (mean, 13 days; median, 14 days; range, 1 to 27 days) of developing IMHA (P < .0001), whereas in the control group no marked increase in frequency of presentation was seen in the first month after vaccination. The dogs with IMHA were divided into 2 groups based on time since vaccination: the vaccine IMHA group included dogs vaccinated within 1 month of developing IMHA; the nonvaccine IMHA group included dogs that developed IMHA more than 1 month after vaccination. The recently vaccinated dogs with IMHA (vaccine IMHA group) had significantly lower platelet counts (P < .05) and a trend towards increased prevalence of intravascular hemolysis and autoagglutination when compared with the nonvaccine IMHA group. Similar mortality rates were seen in teh vaccine IMHA group (60%) and the nonvaccine IMHA group (44%), with the majority of fatalities (> 75%) occurring in the first 3 weeks after presentation. Persistent autoagglutination was a negative prognostic indicator for survival in both groups (P < .05). Presence of icterus and hyperbilirubinemia were negative prognostic indicators for survival in the nonvaccine IMHA group (P < .0001 and P < .01, respectively) but not in the vaccine IMHA group. In the recently vaccinated dogs, combination vaccines from various manufacturers against canine distemper, adenovirus type 2, leptospirosis, parainfluenza, and parvovirus (DHLPP) were involved in each case. Vaccines against rabies virus, Bordetella spp, coronavirus, and Lyme Borrelia were administrated concomitantly to some dogs. This study provides the first clinical evidence for a temporal relationship of vaccine-associated IMHA in the dog.
Collapse
Affiliation(s)
- D Duval
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia 19104-6010, USA
| | | |
Collapse
|
11
|
Shurin SB, Anderson P, Zollinger J, Rathbun RK. Pathophysiology of hemolysis in infections with Hemophilus influenzae type b. J Clin Invest 1986; 77:1340-8. [PMID: 3485660 PMCID: PMC424492 DOI: 10.1172/jci112439] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The capsular polysaccharide of Hemophilus influenzae type b, polyribosyl ribitol phosphate (PRP), is released from growing organisms during human infection and can be found in body fluids. It binds to untreated erythrocytes. Many patients with invasive infections with this organism develop significant hemolysis, but the mechanism has been unclear. We have found that PRP binds to human erythrocytes in vivo. PRP-coated erythrocytes have a shortened circulation time in mice, but do not lyse spontaneously or fix complement. PRP-coated erythrocytes exposed to antiserum to H. influenzae type b are undamaged in the absence of complement, but are rapidly and effectively lysed in the presence of an intact complement system both in vitro and in vivo in mice. PRP-coated red cells are taken up by liver and spleen. Antiserum to PRP increases hepatic uptake of PRP-coated red cells more than splenic, and appears to induce intravascular, complement-mediated hemolysis, as well as extravascular hemolysis. Patients with invasive infection develop hemolysis when circulating PRP and antibody to PRP are present simultaneously. PRP can sometimes be detected on patient erythrocytes when free PRP is present in serum, but this is an inconsistent finding. The hemolytic anemia that occurs during human infection with H. influenzae type b may be due to absorption of PRP to red cells and immune destruction of sensitized erythrocytes. The process requires an intact complement system; both complement-mediated cell lysis and extravascular hemolysis contribute to red cell destruction.
Collapse
|
12
|
Yam P, Wilkinson L, Petz LD, Garratty G. Studies on hemolytic anemia in pregnancy with evidence for autoimmunization in a patient with a negative direct antiglobulin (Coombs') test. Am J Hematol 1980; 8:23-9. [PMID: 7395861 DOI: 10.1002/ajh.2830080104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
13
|
Winsnes R. Quantification of tetanus antitoxin in human sera. I. Counter-immunoelectrophoresis. ACTA PATHOLOGICA ET MICROBIOLOGICA SCANDINAVICA. SECTION B, MICROBIOLOGY 1979; 87B:191-5. [PMID: 474132 DOI: 10.1111/j.1699-0463.1979.tb02424.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An extensive sero-epidemiological survey of immunity to tetanus is to be performed in Norway during 1978 and 1979 and thus a simple and reliable method for screening sera for content of tetanus antitoxin is needed. An improved counter-immunoelectrophoretic method for quantification of tetanus antitoxin is described. The toxin neutralization test in mice is considered to correlate well with protection in humans. Counter-immunoelectrophoresis has the advantage of using tetanus toxoid instead of toxin as well as being more rapid and less expensive. Specific antibodies of the IgG, IgM, and IgA classes could be read simultaneously for many sera. This may be of importance, since it is reported in the literature that only antibody of the IgG class is capable of neutralizing tetanus toxin in mice. Counter-immunoelectrophoresis is limited by being less sensitive than the toxin neutralization test in mice.
Collapse
|