1
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Lipman T, Bienz MN, Pendergrast J, Cserti-Gazdewich C, Branch DR. Unexpected difficulty in performance of a monocyte monolayer assay when using RBCs from a patient with sickle cell disease. Transfusion 2024; 64:4-5. [PMID: 37971163 DOI: 10.1111/trf.17605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Tatiana Lipman
- Centre for Innovation, Canadian Blood Services, Keenan Research Centre, Toronto, Ontario, Canada
| | - Marc Nicolas Bienz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jacob Pendergrast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Donald R Branch
- Centre for Innovation, Canadian Blood Services, Keenan Research Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Batarfi K, Liu Y, Nixon J, Webert KE, John MS, Karunakaran M, Alhomsi N, Park JJ, Heddle NM. A retrospective analysis of haemolytic reactions to intravenous immunoglobulin using data from the Transfusion-Transmitted Injuries Surveillance System (Ontario). Vox Sang 2023; 118:753-762. [PMID: 37592865 DOI: 10.1111/vox.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/08/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Haemolysis can occur following intravenous immunoglobulin (IVIG) infusion. Haemovigilance data were analysed using a novel approach for including two control groups with no haemolysis to IVIG. Objectives included a summary of all reactions to IVIG, rate estimates and analysis of haemolytic reactions including risk factors. MATERIALS AND METHODS Canadian haemovigilance data from Ontario (2013-2021), IVIG distribution and transfusion data from the blood supplier, and data from a large local transfusion registry were used. An 'other-reactions' control group included patients with IVIG reactions that were not haemolytic, and registry patients with no-reaction were the 'no-reaction controls'. Descriptive analysis and two logistic regression models for the different control groups were performed. RESULTS One thousand one hundred and seventy reactions were included. Most common were febrile non haemolytic (26.1%), minor allergic (24.5%) and IVIG headache (15.3%) followed by haemolytic 10.9% (128/1170). Haemolytic reaction rates decreased over time: rates since 2020 estimated between 1.5 and 2.9/1000 kg IVIG used. The regression model for other-reaction controls identified two risk factors for haemolysis: non-O blood group recipients compared with group O recipients (p value = 0.0106) and IVIG dose per 10 g increase (OR 1.359; 95% CI 1.225-1.506). The model using no-reaction controls gave similar results and also showed no pre-medication was associated with a higher risk of haemolysis (OR 29.084; 95% CI 1.989-425.312). CONCLUSION The frequency of haemolytic reactions has decreased over time. We confirmed non-O blood group recipients and IVIG dose as risk factors for haemolysis and raise the hypothesis that no pre-medication may increase the risk of haemolysis.
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Affiliation(s)
- Khalid Batarfi
- Transfusion Medicine Services, Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yang Liu
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joanne Nixon
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn E Webert
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Melanie St John
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meera Karunakaran
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nour Alhomsi
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jane J Park
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
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3
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Sandhu G, Lipman T, Bodnar M, Bienz MN, Branch DR. Significant rosettes observed in monocyte monolayer assay due to complement-binding antibodies. Transfusion 2023. [PMID: 37114749 DOI: 10.1111/trf.17384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Gurleen Sandhu
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Tatiana Lipman
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Melanie Bodnar
- Medical Laboratory and Stem Cell Services, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Marc Nicolas Bienz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Donald R Branch
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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4
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Boligan KF, Sandhu G, Branch DR. Methods to Evaluate the Potential Clinical Significance of Antibodies to Red Blood Cells. Curr Protoc 2022; 2:e504. [PMID: 35926124 DOI: 10.1002/cpz1.504] [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] [Indexed: 06/15/2023]
Abstract
Immune-mediated red blood cell (RBC) destruction due to antibodies is an ongoing problem in transfusion medicine for the selection of the safest blood. Serological testing often revealed incompatibility with donors' RBCs. When this incompatible blood was transfused, destruction was due mostly to extravascular-mediated phagocytosis of the antibody-opsonized RBCs; however, intravascular hemolysis was sometimes observed without explanation. Based on serology, antibodies with potential for clinical sequalae could not be ascertained; thus, antigen-negative blood was usually selected for transfusion to avoid problems. Antibodies to antigens having very high frequency in the general population (>95%), however, made selection of antigen-negative blood difficult and sometimes impossible. Some patients, who were sensitized by previous transfusions or by pregnancy, developed multiple antibodies, again creating a problem for finding compatible blood for transfusion, without the ability to discern which of the antibodies may be clinically irrelevant and ignored. Transfusion medicine scientists began searching for an in vitro means to determine the in vivo outcome of transfusion of blood that was serologically incompatible. Methods such as chemiluminescence, monocyte-macrophage phagocytosis, and antibody-dependent cellular cytotoxicity (ADCC) were described. Over the years, the monocyte monolayer assay (MMA) has emerged as the most reliable in vitro assay for the prediction of the clinical relevance of a given antibody. ADCC has not been fully studied but has the potential to be useful for predicting which antibodies may result in intravascular hemolysis. This article captures the protocols for the implementation and readout of the MMA and ADCC assays for use in predicting the clinical significance of antibodies in a transfusion setting. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Monocyte monolayer assay (MMA) Basic Protocol 2: Antibody-dependent cellular cytotoxicity assay (ADCC).
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Affiliation(s)
| | - Gurleen Sandhu
- Centre for Innovation, Canadian Blood Services, Toronto, Canada
| | - Donald R Branch
- Centre for Innovation, Canadian Blood Services, Toronto, Canada
- Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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5
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Branch DR, Almizraq RJ, Bussel JB. Hemolysis after high-dose intravenous immunoglobulin: An under-appreciated sequelae. Am J Hematol 2022; 97:E183-E185. [PMID: 35170068 DOI: 10.1002/ajh.26501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Donald R. Branch
- Centre for Innovation Canadian Blood Services Toronto Ontario Canada
- Department of Medicine University of Toronto Toronto Ontario Canada
| | | | - James B. Bussel
- Department of Pediatrics Weill Cornell Medical College New York New York USA
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6
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Treatment-associated hemolysis in Kawasaki disease: association with blood-group antibody titers in IVIG products. Blood Adv 2021; 4:3416-3426. [PMID: 32722782 DOI: 10.1182/bloodadvances.2020002253] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
Hemolytic anemia resulting from IV Immunoglobulin (IVIG) treatment can be a serious complication, especially for those with underlying conditions with a high level of inflammation and after administration of high IVIG dosages, such as Kawasaki disease (KD), a multisystem vasculitis affecting young children. This hemolysis is caused by antibodies against blood groups A and B, but the precise mechanism for hemolysis is not known. We performed a single center, partly retrospective, partly prospective study of a cohort of 581 patients who received IVIG for treatment of KD from 2006 to 2013. Factors associated with hemolysis were identified through univariable and multivariable logistic regression. Six IVIG preparations were assayed for their hemolytic effect with serological and cellular assays to clarify the mechanism of red cell destruction. During the study period, a sudden increase in the incidence of hemolysis was observed, which coincided with the introduction of new IVIG preparations in North America that contained relatively high titers of anti-A and anti-B. These blood-group-specific antibodies were of the immunoglobulin G2 (IgG2) subclass and resulted in phagocytosis by monocyte-derived macrophages in an FcγRIIa-dependent manner. Phagocytosis was increased in the presence of proinflammatory mediators that mimicked the inflammatory state of KD. An increased frequency of severe hemolysis following IVIG administration was caused by ABO blood-group-specific IgG2 antibodies leading to FcγRIIa-dependent clearance of erythrocytes. This increase in adverse events necessitates a reconsideration of the criteria for maximum titer (1:64) of anti-A and anti-B in IVIG preparations.
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7
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Pendergrast J, Armali C, Callum J, Cserti-Gazdewich C, Jiwajee A, Lieberman L, Lau W, Lin Y, Parmar N, Pavenski K, Riden LS, Shehata N, Willie-Ramharack K, Tomlinson G, Tong TN, Binnington B, Branch DR. A prospective observational study of the incidence, natural history, and risk factors for intravenous immunoglobulin-mediated hemolysis. Transfusion 2021; 61:1053-1063. [PMID: 33433931 DOI: 10.1111/trf.16232] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Intravenous Immune Globulin (IVIG) is used to treat numerous immune-mediated and inflammatory conditions. There is growing awareness of hemolysis, occasionally severe, as a side-effect of this therapy. While most cases are associated with anti-A and/or anti-B isoagglutinins, the frequency and mechanism of hemolysis remain poorly characterized. STUDY DESIGN AND METHODS A prospective observational study was conducted to determine incidence, natural history and risk factors for IVIG-mediated hemolysis. A total of 99 infusions of high-dose IVIG (2 g/kg or higher) administered to 78 non-group O patients were monitored and graded according to Canadian IVIG Hemolysis Pharmacovigilance Group. Serum ferritin and C3/C4 levels were monitored as indicators of macrophage activation and complement consumption, respectively. Supplementary investigations included assessment for ABO zygosity, Secretor status, FcR polymorphisms, eluate IgG subclass, monocyte monolayer assay, and a panel of cytokines. RESULTS Hemolysis was observed in 32 of 99 (32%) of infusions, with 19 of 99 (19%) grade 2 or higher. Hemolysis was only apparent 5-10 days after a completed IVIG infusion in 84% of cases and was associated with increases in serum ferritin without complement-consumption. In univariate analysis, increased risk was observed in group AB patients, first-time IVIG recipients, those not taking immuosuppressive medications, or patients treated with a specific IVIG brand; however, in multivariate analysis, product association was no longer observed. No other patient- or practice-related risk factors were identified. CONCLUSION IVIG-mediated hemolysis is common and frequently severe. Monitoring for 5-10 days following an infusion should be considered in non-O patients receiving high-dose IVIG with known risk factors.
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Affiliation(s)
- Jacob Pendergrast
- Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Chantal Armali
- Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Christine Cserti-Gazdewich
- Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Aziz Jiwajee
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Canada
| | - Lani Lieberman
- Laboratory Medicine Program, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Wendy Lau
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nagina Parmar
- Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Canada
| | | | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Canada
| | | | - George Tomlinson
- Department of Medicine, University Health Network/Mt Sinai Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Tik Nga Tong
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Centre for Innovation, Canadian Blood Services, Toronto, Canada
| | - Beth Binnington
- Centre for Innovation, Canadian Blood Services, Toronto, Canada
| | - Donald R Branch
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Centre for Innovation, Canadian Blood Services, Toronto, Canada
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- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program (QUEST), Toronto, Canada
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8
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Tong TN, Blacquiere M, Sakac D, Burke-Murphy E, Yi Q, Callum J, Cserti-Gazdewich C, Parmar N, Shehata N, Pavenski K, Lau W, Lin Y, Lieberman L, Branch DR, Pendergrast J. The utility of a monocyte monolayer assay in the assessment of intravenous immunoglobulin-associated hemolysis. Transfusion 2020; 60:3010-3018. [PMID: 33091964 DOI: 10.1111/trf.16131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/10/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hemolysis following the administration of intravenous immunoglobulin (IVIG) is an important adverse event (AE). While the monocyte monolayer assay (MMA) has been used to predict in vivo hemolysis when serologically incompatible blood may be transfused, it has also been shown to correlate with IVIG-associated hemolysis. In this study, the MMA was examined for its utility in assessing the risk of hemolysis after IVIG. STUDY DESIGN AND METHODS Forty-two non-blood group O patients receiving high-dose IVIG (≥2 g/kg) were examined using an autologous and allogeneic MMA. Hemolysis was defined by a drop in hemoglobin of ≥1 g/L, a positive direct antiglobulin test (DAT) and eluate, and a decrease in haptoglobin or increase in lactate dehydrogenase and/or reticulocytes. RESULTS Forty-two patients provided 50 assessable postinfusion samples, with hemolysis observed in 20 (40%) of cases. Autologous MMA using post-IVIG red blood cells significantly correlated with clinical outcomes when compared to allogeneic MMA (P = .0320 vs .5806, t test). No significant difference in receiver operating characteristics was observed when comparing autologous MMA testing against DAT for the diagnosis of IVIG-associated hemolysis. However, when using samples collected 5 to 10 days after receipt of high-dose IVIG, the autologous MMA had higher sensitivity than the DAT. CONCLUSION MMA testing with autologous monocytes collected 5 to 10 days after receipt of high-dose IVIG can be used for the diagnosis of IVIG-associated hemolysis and may be of particular value in cases in which the Day 5 to 10 DAT is negative.
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Affiliation(s)
- Tik Nga Tong
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Megan Blacquiere
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Darinka Sakac
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | | | - Qilong Yi
- Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christine Cserti-Gazdewich
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Nagina Parmar
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Nadine Shehata
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Wendy Lau
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada.,Department of Transfusion Medicine, Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Donald R Branch
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada.,Departments of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacob Pendergrast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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9
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Van Anh KVY, Shah S, Tremoulet AH. Hemolysis From Intravenous Immunoglobulin in Obese Patients With Kawasaki Disease. Front Pediatr 2020; 8:146. [PMID: 32318529 PMCID: PMC7146618 DOI: 10.3389/fped.2020.00146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/13/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: We assessed the risk of IVIG-associated hemolytic anemia in patients with acute Kawasaki disease (KD) and evaluated the risk of weight-based dosing in our obese patients. Methods: IVIG-associated hemolytic anemia was assessed in acute KD patients treated with IVIG at Rady Children's Hospital-San Diego. Patients in whom hemolytic anemia was suspected had a decrease in z-score of their hemoglobin (zHgb) at least two standard deviations below the cohort's mean change in zHgb from baseline to 2 weeks post-IVIG treatment. These patients were further evaluated for spherocytosis, blood type, need for transfusion, red cell distribution width, reticulocytosis, and direct Coombs test. Body mass index was calculated. Results: Of the 30 IVIG-resistant KD patients who received a second dose of IVIG, 2 (6.7%) developed hemolytic anemia after a total of 4 g/kg of IVIG dosed on actual body weight, or a mean of 4.6 g/kg of IVIG based on lean body mass. Compared to 496 non-obese KD patients who received a single dose of IVIG with no cases of hemolytic anemia, two (5.6%) of 36 obese KD patients developed hemolytic anemia after a single dose of IVIG (2 g/kg) dosed on actual body weight, or a mean of 2.7 g/kg IVIG based on lean body mass. Conclusions: In addition to following patients carefully for hemolytic anemia after a second dose of IVIG, physicians should consider IVIG dosing based on lean body mass for obese patients.
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Affiliation(s)
| | - Saloni Shah
- Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, United States
| | - Adriana H Tremoulet
- Department of Pediatrics and Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, United States
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10
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Cen SY, Branch DR. Isoagglutinin-reduced immunoglobulin retains efficacy in mouse models of immune thrombocytopenia and rheumatoid arthritis and is less likely to cause intravenous immunoglobulin-associated hemolysis. Transfusion 2019; 60:250-255. [PMID: 31837028 PMCID: PMC7496430 DOI: 10.1111/trf.15622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Immunoglobulin therapy including intravenous immunoglobulin (IVIg) has been used as an effective treatment for autoimmune/inflammatory conditions with few side effects. However, high‐dose IVIg (1‐2 g/kg) has been recognized as a cause of hemolytic anemia in non–blood group O patients. Hemolysis when observed has been due to anti‐A/anti‐B isoagglutinins contained in the IVIg. Recently, an isoagglutinin‐reduced IVIg, whereby the anti‐A and anti‐B titers have been reduced by immunoaffinity chromatography, has been introduced; however, whether this new product is as efficacious as nonreduced immunoglobulin (Ig) or will result in less IVIg‐associated hemolysis has not been resolved. STUDY DESIGN AND METHODS We used in vitro phagocytosis by monocytes and proinflammatory/anti‐inflammatory macrophages, with isoagglutinin‐reduced and ‐nonreduced Ig opsonized group A1, B, and A1B red blood cells, to estimate clinical significance of the IgG isoagglutinins. We also used immune thrombocytopenia (ITP) and rheumatoid arthritis (RA) mouse models to examine the in vivo efficacy of isoagglutinin‐reduced versus ‐nonreduced Ig on the amelioration of the diseases. RESULTS In contrast to nonreduced Ig, phagocytosis was largely absent when isoagglutinin‐reduced Ig was used at a concentration equivalent to a patient receiving 2 g/kg. The in vivo efficacy of isoagglutinin‐reduced versus nonreduced Ig on the amelioration of experimental ITP and RA was similar, indicating no loss of efficacy due to the chromatographic removal of isoagglutinins. CONCLUSION Isoagglutinin‐reduced Ig should have efficacy similar to nonreduced Ig and result in less IVIg‐associated hemolysis.
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Affiliation(s)
- Selena Y Cen
- Center for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Donald R Branch
- Center for Innovation, Canadian Blood Services, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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11
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Tong TN, Cen S, Branch DR. The Monocyte Monolayer Assay: Past, Present and Future. Transfus Med Rev 2019; 33:24-28. [DOI: 10.1016/j.tmrv.2018.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 11/24/2022]
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12
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Kipkeu BJ, Shyian ML, da Silveira Cavalcante L, Duong TT, Yeung RS, Binnington B, Branch DR, Acker JP, Holovati JL. Evaluation of the functional properties of cryopreserved buffy coat-derived monocytes for monocyte monolayer assay. Transfusion 2018; 58:2027-2035. [DOI: 10.1111/trf.14650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Betty J. Kipkeu
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
| | - Melissa L. Shyian
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
| | | | | | - Rae S.M. Yeung
- The Hospital for Sick Children; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
| | - Beth Binnington
- Centre for Innovation; Canadian Blood Services; Toronto Ontario Canada
| | - Donald R. Branch
- Centre for Innovation; Canadian Blood Services; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
| | - Jason P. Acker
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
- Centre for Innovation; Canadian Blood Services; Edmonton Alberta Canada
| | - Jelena L. Holovati
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton Alberta Canada
- Centre for Innovation; Canadian Blood Services; Edmonton Alberta Canada
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13
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ABO zygosity, but not secretor or Fc receptor status, is a significant risk factor for IVIG-associated hemolysis. Blood 2018; 131:830-835. [PMID: 29305554 DOI: 10.1182/blood-2017-07-796151] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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14
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Yazer MH, Seheult J, Kleinman S, Sloan SR, Spinella PC. Who's afraid of incompatible plasma? A balanced approach to the safe transfusion of blood products containing ABO-incompatible plasma. Transfusion 2017; 58:532-538. [PMID: 29193106 DOI: 10.1111/trf.14415] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jansen Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Steven R Sloan
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, Missouri
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15
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Tong TN, Branch DR. Use of a Monocyte Monolayer Assay to Evaluate Fcγ Receptor-mediated Phagocytosis. J Vis Exp 2017. [PMID: 28117787 PMCID: PMC5408648 DOI: 10.3791/55039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Although originally developed for predicting transfusion outcomes of serologically incompatible blood, the monocyte monolayer assay (MMA) is a highly versatile in vitro assay that can be modified to examine different aspects of antibody and Fcγ receptor (FcγR)-mediated phagocytosis in both research and clinical settings. The assay utilizes adherent monocytes from peripheral blood mononuclear cells isolated from mammalian whole blood. MMA has been described for use in both human and murine investigations. These monocytes express FcγRs (e.g., FcγRI, FcγRIIA, FcγRIIB, and FcγRIIIA) that are involved in immune responses. The MMA exploits the mechanism of FcγR-mediated interactions, phagocytosis in particular, where antibody-sensitized red blood cells (RBCs) adhere to and/or activate FcγRs and are subsequently phagocytosed by the monocytes. In vivo, primarily tissue macrophages found in the spleen and liver carry out FcγR-mediated phagocytosis of antibody-opsonized RBCs, causing extravascular hemolysis. By evaluating the level of phagocytosis using the MMA, different aspects of the in vivo FcγR-mediated process can be investigated. Some applications of the MMA include predicting the clinical relevance of allo- or autoantibodies in a transfusion setting, assessing candidate drugs that promote or inhibit phagocytosis, and combining the assay with fluorescent microscopy or traditional Western immunoblotting to investigate the downstream signaling effects of FcγR-engaging drugs or antibodies. Some limitations include the laboriousness of this technique, which takes a full day from start to finish, and the requirement of research ethics approval in order to work with mammalian blood. However, with diligence and adequate training, the MMA results can be obtained within a 24-h turnover time.
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Affiliation(s)
- Tik Nga Tong
- Department of Laboratory Medicine and Pathobiology, University of Toronto
| | - Donald R Branch
- Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Innovation, Canadian Blood Services;
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Tong TN, Burke-Murphy E, Sakac D, Pendergrast J, Cserti-Gazdewich C, Laroche V, Branch DR. Optimal conditions for the performance of a monocyte monolayer assay. Transfusion 2016; 56:2680-2690. [DOI: 10.1111/trf.13766] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/14/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Tik Nga Tong
- Department of Laboratory Medicine and Pathobiology; Canadian Blood Services; Toronto, Ontario
- Centre for Innovation; Canadian Blood Services
| | | | | | | | | | | | - Donald R. Branch
- Department of Laboratory Medicine and Pathobiology; Canadian Blood Services; Toronto, Ontario
- Centre for Innovation; Canadian Blood Services
- University Health Network; Toronto, Ontario Canada
- Department of Medicine; University of Toronto
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Neschadim A, Kotra LP, Branch DR. Small molecule phagocytosis inhibitors for immune cytopenias. Autoimmun Rev 2016; 15:843-7. [PMID: 27296447 DOI: 10.1016/j.autrev.2016.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/07/2016] [Indexed: 01/19/2023]
Abstract
Immune cytopenias are conditions characterized by low blood cell counts, such as platelets in immune thrombocytopenia (ITP) and red blood cells in autoimmune hemolytic anemia (AIHA). Chronic ITP affects approximately 4 in 100,000 adults annually while AIHA is much less common. Extravascular phagocytosis and massive destruction of autoantibody-opsonized blood cells by macrophages in the spleen and liver are the hallmark of these conditions. Current treatment modalities for ITP and AIHA include the first-line use of corticosteroids; whereas, IVIg shows efficacy in ITP but not AIHA. One main mechanism of action by which IVIg treatment leads to the reduction in platelet destruction rates in ITP is thought to involve Fcγ receptor (FcγR) blockade, ultimately leading to the inhibition of extravascular platelet phagocytosis. IVIg, which is manufactured from the human plasma of thousands of donors, is a limited resource, and alternative treatments, particularly those based on bioavailable small molecules, are needed. In this review, we overview the pathophysiology of ITP, the role of Fcγ receptors, and the mechanisms of action of IVIg in treating ITP, and outline the efforts and progress towards developing novel, first-in-class inhibitors of phagocytosis as synthetic, small molecule substitutes for IVIg in ITP and other conditions where the pathobiology of the disease involves phagocytosis.
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Affiliation(s)
- Anton Neschadim
- Centre for Innovation, Canadian Blood Services, Toronto, ON, Canada
| | - Lakshmi P Kotra
- Center for Molecular Design and Preformulations, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; McLaughlin Center for Molecular Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Donald R Branch
- Centre for Innovation, Canadian Blood Services, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Advanced Diagnostics, Infection and Immunity Group, Toronto General Hospital Research Institute, Toronto, ON, Canada.
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Tong TN, Cserti-Gazdewich CM, Branch DR. Value of MMA crossmatch? Transfus Med 2016; 26:301-2. [PMID: 27144777 DOI: 10.1111/tme.12311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
Affiliation(s)
- T N Tong
- University Health Network and Centre for Innovation, Canadian Blood Services, Toronto, Canada
| | - C M Cserti-Gazdewich
- University Health Network and Centre for Innovation, Canadian Blood Services, Toronto, Canada
| | - D R Branch
- University Health Network and Centre for Innovation, Canadian Blood Services, Toronto, Canada.
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Pulvirenti F, Granata G, Girelli G, Quinti I. Immunoglobulin-induced hemolysis, splenomegaly and inflammation in patients with antibody deficiencies. Expert Rev Clin Immunol 2016; 12:725-31. [PMID: 26854522 DOI: 10.1586/1744666x.2016.1151787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
IgG replacement for primary antibody deficiencies is a safe treatment administered to prevent recurrent infections and reduce mortality. Recently, several reports described acute hemolytic episodes following IgG administration due to a passive transfer of blood group alloantibodies, including anti-A, anti-B, as well as anti-Rh antibodies. Here, we reviewed and discussed the consequences of passively transferred RBCs antibodies. The chronic passive transfer of alloantibodies might also cause a subclinical condition due to a compensated extravascular chronic hemolysis with poorly understood consequences. This phenomenon might possibly represent an unrecognized cause of splenomegaly and might contribute to inflammation in patients with primary antibody deficiencies.
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Affiliation(s)
- Federica Pulvirenti
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
| | - Guido Granata
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
| | - Gabriella Girelli
- b Unit of Immunohematology and Transfusion Medicine , Sapienza University of Rome , Rome , Italy
| | - Isabella Quinti
- a Centre for Primary Immune Deficiencies, Department of Molecular Medicine , Sapienza University of Rome , Rome , Italy
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20
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Flegel WA. Pathogenesis and mechanisms of antibody-mediated hemolysis. Transfusion 2015; 55 Suppl 2:S47-58. [PMID: 26174897 DOI: 10.1111/trf.13147] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical consequences of antibodies to red blood cells (RBCs) have been studied for a century. Most clinically relevant antibodies can be detected by sensitive in vitro assays. Several mechanisms of antibody-mediated hemolysis are well understood. Such hemolysis after transfusion is reliably avoided in a donor-recipient pair, if one individual is negative for the cognate antigen to which the other has the antibody. STUDY DESIGN AND RESULTS Mechanisms of antibody-mediated hemolysis were reviewed based on a presentation at the Strategies to Address Hemolytic Complications of Immune Globulin Infusions Workshop addressing intravenous immunoglobulin (IVIG) and ABO antibodies. The presented topics included the rates of intravascular and extravascular hemolysis; immunoglobulin (Ig)M and IgG isoagglutinins; auto- and alloantibodies; antibody specificity; A, B, A,B, and A1 antigens; A1 versus A2 phenotypes; monocytes-macrophages, other immune cells, and complement; monocyte monolayer assay; antibody-dependent cell-mediated cytotoxicity; and transfusion reactions due to ABO and other antibodies. CONCLUSION Several clinically relevant questions remained unresolved, and diagnostic tools were lacking to routinely and reliably predict the clinical consequences of RBC antibodies. Most hemolytic transfusion reactions associated with IVIG were due to ABO antibodies. Reducing the titers of such antibodies in IVIG may lower the frequency of this kind of adverse event. The only way to stop these events is to have no anti-A or anti-B in the IVIG products.
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Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
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Pendergrast J, Willie-Ramharack K, Sampson L, Laroche V, Branch DR. The role of inflammation in intravenous immune globulin-mediated hemolysis. Transfusion 2015; 55 Suppl 2:S65-73. [PMID: 26174900 DOI: 10.1111/trf.13097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Intravenous immune globulin (IVIG) therapy has shown great success in a number of autoimmune and inflammatory conditions and its use continues to increase worldwide. There is growing awareness of significant side effects of high-dose IVIG: however, particularly severe hemolysis in patients that are non-group O. It has been proposed that IVIG-associated hemolysis may be heralded by an existing inflammatory condition. In the work presented herein, we have provided a review of the pathophysiology of inflammation, particularly as it applies in immune-mediated red blood cell hemolysis, and a summary of previous publications that suggest an association between IVIG-mediated hemolysis and a state of existing inflammation. In addition, preliminary results from a prospective study to address the mechanism of IVIG-associated hemolysis are provided. These preliminary data support the idea of an existing inflammatory condition preceding overt hemolysis after high-dose IVIG therapy that: 1) is restricted to non-group O patients, 2) is seen when using IVIG doses of more than 2 g/kg, 3) involves an activated mononuclear phagocyte system, 4) may be presaged by a significant increase in the anti-inflammatory cytokine interleukin-1 receptor agonist, and 5) is independent of secretor status.
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Affiliation(s)
- Jacob Pendergrast
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | | | - Lorna Sampson
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Vincent Laroche
- Institut Universitaire de Cardiologie et Pneumologie de Québec & CHU de Québec and Hôpitaux Enfant-Jésus et Saint-Sacrement, Quebec City, Quebec, Canada
| | - Donald R Branch
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
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Padmore R. Possible mechanisms for intravenous immunoglobulin-associated hemolysis: clues obtained from review of clinical case reports. Transfusion 2015; 55 Suppl 2:S59-64. [DOI: 10.1111/trf.13090] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/23/2015] [Accepted: 02/27/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Ruth Padmore
- Ottawa Hospital and Eastern Ontario Regional Laboratory Association and University of Ottawa; Ottawa Ontario Canada
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Branch DR. Anti-A and anti-B: what are they and where do they come from? Transfusion 2015; 55 Suppl 2:S74-9. [DOI: 10.1111/trf.13087] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/24/2015] [Accepted: 01/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Donald R. Branch
- Centre for Innovation, Canadian Blood Services; and the Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto; Toronto Ontario Canada
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Berg R, Shebl A, Kimber MC, Abraham M, Schreiber GB. Hemolytic events associated with intravenous immune globulin therapy: a qualitative analysis of 263 cases reported to four manufacturers between 2003 and 2012. Transfusion 2015; 55 Suppl 2:S36-46. [DOI: 10.1111/trf.13198] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Späth PJ, Granata G, La Marra F, Kuijpers TW, Quinti I. On the dark side of therapies with immunoglobulin concentrates: the adverse events. Front Immunol 2015; 6:11. [PMID: 25699039 PMCID: PMC4318428 DOI: 10.3389/fimmu.2015.00011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/07/2015] [Indexed: 12/26/2022] Open
Abstract
Therapy by human immunoglobulin G (IgG) concentrates is a success story ongoing for decades with an ever increasing demand for this plasma product. The success of IgG concentrates on a clinical level is documented by the slowly increasing number of registered indication and the more rapid increase of the off-label uses, a topic dealt with in another contribution to this special issue of Frontiers in Immunology. A part of the success is the adverse event (AE) profile of IgG concentrates which is, even at life-long need for therapy, excellent. Transmission of pathogens in the last decade could be entirely controlled through the antecedent introduction by authorities of a regulatory network and installing quality standards by the plasma fractionation industry. The cornerstone of the regulatory network is current good manufacturing practice. Non-infectious AEs occur rarely and mainly are mild to moderate. However, in recent times, the increase in frequency of hemolytic and thrombotic AEs raised worrying questions on the possible background for these AEs. Below, we review elements of non-infectious AEs, and particularly focus on hemolysis and thrombosis. We discuss how the introduction of plasma fractionation by ion-exchange chromatography and polishing by immunoaffinity chromatographic steps might alter repertoire of specificities and influence AE profiles and efficacy of IgG concentrates.
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Affiliation(s)
- Peter J. Späth
- Institute of Pharmacology, University of Berne, Berne, Switzerland
| | - Guido Granata
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabiola La Marra
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Taco W. Kuijpers
- Department of Pediatric Hematology, Immunology and Infectious Disease, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Affiliation(s)
- Radhika Dasararaju
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marisa B. Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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Quinti I, Pulvirenti F, Milito C, Granata G, Giovannetti G, La Marra F, Pesce AM, Farrugia A, Coluzzi S, Girelli G. Hemolysis in patients with antibody deficiencies on immunoglobulin replacement treatment. Transfusion 2014; 55:1067-74. [PMID: 25532440 DOI: 10.1111/trf.12939] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/29/2014] [Accepted: 10/03/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Immunoglobulin (Ig)G replacement with intravenous or subcutaneous immunoglobulins is a lifelong substitutive therapy in patients with primary antibody deficiencies (PADs). Hemolysis after immunoglobulin therapy was described in patients receiving high immunoglobulin dosages. The issue of hemolysis after immunoglobulin administration at replacement doses has been considered of little clinical significance. STUDY DESIGN AND METHODS This was a single-center observational study over a 2-year period on immunoglobulin-induced hemolysis in a cohort of 162 patients with PADs treated with immunoglobulin administered at replacement dosages. RESULTS Six patients had signs and symptoms of immunoglobulin-induced hemolysis. Two additional asymptomatic patients were identified by a short-term study run on 16 randomly selected asymptomatic patients. Alloantibodies eluted from patients' red blood cells (RBCs) had anti-A and Rh specificities (anti-D and anti-C). The immunoglobulins contained alloantibodies with the same specificities of the antibodies eluted from patients' RBCs. CONCLUSION Hemolysis occurred in patients receiving immunoglobulin at replacement dosages. Polyvalent immunoglobulin preparations contained multiple clinically significant antibodies that could have unexpected hemolytic consequences, as anti-C whose research and titration are not required by the European Pharmacopoeia. The issue of hemolysis in long-term recipients of immunoglobulin treatment administered at replacement dosages should be more widely recognized.
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Affiliation(s)
- Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Guido Granata
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Giovannetti
- Unit of Immunohematology and Transfusion Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabiola La Marra
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Anna M Pesce
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Albert Farrugia
- Plasma Protein Therapeutics Association, Annapolis, Maryland.,School of Surgery, University of Western Australia, Crawley, Western Australia, Australia.,School of Medicine, Australian National University, Canberra, Australia
| | - Serelina Coluzzi
- Unit of Immunohematology and Transfusion Medicine, Sapienza University of Rome, Rome, Italy
| | - Gabriella Girelli
- Unit of Immunohematology and Transfusion Medicine, Sapienza University of Rome, Rome, Italy
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Structure–activity relationships of pyrazole derivatives as potential therapeutics for immune thrombocytopenias. Bioorg Med Chem 2014; 22:2739-52. [DOI: 10.1016/j.bmc.2014.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/01/2014] [Accepted: 03/10/2014] [Indexed: 11/23/2022]
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