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Lazana I, Apap Mangion S, Babiker S, Large J, Trikha R, Zuckerman M, Gandhi S, Kulasekararaj AG. The Effect of Respiratory Viral Infections on Breakthrough Hemolysis in Patients with Paroxysmal Nocturnal Hemoglobinuria. Int J Mol Sci 2023; 24:ijms24119358. [PMID: 37298309 DOI: 10.3390/ijms24119358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/17/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by hemolysis and thrombosis and is associated with significant morbidity and mortality. Although complement inhibitors have significantly changed the outcomes in PNH patients, breakthrough hemolysis (BTH) may still occur as a response to stress factors such as pregnancy, surgery, and infections. Despite the well-described association between bacterial infections and hemolysis in PNH patients, little is known about the effect of respiratory viruses on triggering hemolytic episodes. This is the first study, to our knowledge, addressing this question. We retrospectively analyzed 34 patients with PNH disease between 2016 and 2018, who were on eculizumab treatment and who presented with respiratory symptoms and were subsequently tested for 10 respiratory viruses (influenza A, influenza B, parainfluenza, respiratory syncytial virus, adenovirus, rhinovirus, and human metapneumovirus). NTS+ patients had higher inflammatory markers, with the majority requiring antibiotics. Acute hemolysis, along with a significant drop in hemoglobin, was noted in the NTS+ group, with three of them requiring a top-up transfusion and two requiring an extra dose of eculizumab. Furthermore, the time from the last eculizumab dose was longer in the NTS+ patients who had BTH, than those who did not. Our data indicate that respiratory virus infections pose a significant risk for BTH in PNH patients on complement inhibitor treatment, underlining the need for regular screening and close monitoring of patients with respiratory symptoms. Furthermore, it implies a higher risk for patients who are not established on complement inhibitors, suggesting the necessity for greater vigilance in these patients.
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Affiliation(s)
- Ioanna Lazana
- Department of Hematological Medicine, King's College Hospital-NHS Foundation Trust, London SE5 9RS, UK
- Cell and Gene Therapy Laboratory, Biomedical Research Foundation of the Academy of Athens, 115 27 Athens, Greece
| | - Sean Apap Mangion
- Department of Hematological Medicine, King's College Hospital-NHS Foundation Trust, London SE5 9RS, UK
| | - Selma Babiker
- Department of Hematological Medicine, King's College Hospital-NHS Foundation Trust, London SE5 9RS, UK
| | - Joanna Large
- Department of Hematological Medicine, King's College Hospital-NHS Foundation Trust, London SE5 9RS, UK
| | - Roochi Trikha
- Department of Hematological Medicine, King's College Hospital-NHS Foundation Trust, London SE5 9RS, UK
| | - Mark Zuckerman
- Department of Virology, King's College NHS Foundation Trust, London SE5 9RS, UK
| | - Shreyans Gandhi
- Department of Hematological Medicine, King's College Hospital-NHS Foundation Trust, London SE5 9RS, UK
- Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Austin G Kulasekararaj
- Department of Hematological Medicine, King's College Hospital-NHS Foundation Trust, London SE5 9RS, UK
- Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
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Schutgens REG, Pruissen-Peeters KABM, Muus P. A cascade of thromboembolic processes in a patient with paroxysmal nocturnal haemoglobinuria terminated by treatment with eculizumab. Thromb Haemost 2017; 106:383-5. [DOI: 10.1160/th11-03-0165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 04/21/2011] [Indexed: 12/25/2022]
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Satake M, Hoshi Y, Taira R, Momose SY, Hino S, Tadokoro K. Symptomatic parvovirus B19 infection caused by blood component transfusion. Transfusion 2011; 51:1887-95. [PMID: 21332725 DOI: 10.1111/j.1537-2995.2010.03047.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although a risk of transfusion-transmitted human parvovirus B19V (TT-B19V) infection has been a concern, there have been very few reports of clinically relevant TT-B19V caused by the transfusion of a B19V-containing blood component. It has therefore been a matter of debate whether a universal B19V screening with an appropriate sensitivity is required. STUDY DESIGN AND METHODS Through the Japanese Red Cross hemovigilance system, clinical reports on possible TT-B19V were collected from 1999 to 2008, during which B19V donor screening (sensitivity, 10(10) IU/mL) was conducted and repository blood samples from donors were available. RESULTS Eight patients with TT-B19V caused by component transfusion have been identified. Four patients developed sustained anemia and pure red blood cell (RBC) aplasia and one patient developed pancytopenia. The underlying diseases in these five patients were either hematologic malignancy or hemolytic diseases. The viral loads of the responsible components for these cases ranged from 10(3) to 10(8) IU/mL. Two patients who underwent surgical treatment without any hematologic disorder exhibited only moderate symptoms. The B19V DNA sequence identity between a patient and the linked blood donor was confirmed in five of the eight patients. All of the components responsible for the eight cases were positive for anti-B19V immunoglobulin (Ig)M. CONCLUSION Vulnerability to serious B19V-related hematologic disorders depended on the patient's underlying disease state of an enhanced erythropoiesis, not on the viral load of the component transfused. To prevent clinically relevant TT-B19V, a strategy is suggested in which patients at risk of acquiring RBC aplasia or pancytopenia are targeted.
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RIERA NE, ROSSO SALTÓ M, GALÁN V, CANALEJO K, KHOURY M, AIXALÁ M, KANTOR GL, VERMEULEN M, BENGIÓ R, DE BRACCO MME. Anti-polymorphonuclear neutrophil antibodies in patients with leukopenia or neutropenia. Int J Lab Hematol 2010; 32:e96-105. [DOI: 10.1111/j.1751-553x.2009.01173.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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