1
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Cox MF, Mackenzie S, Low R, Brown M, Sanchez E, Carr A, Carpenter B, Bishton M, Duncombe A, Akpabio A, Kulasekararaj A, Sin FE, Jones A, Kavirayani A, Sen ES, Quick V, Dulay GS, Clark S, Bauchmuller K, Tattersall RS, Manson JJ. Diagnosis and investigation of suspected haemophagocytic lymphohistiocytosis in adults: 2023 Hyperinflammation and HLH Across Speciality Collaboration (HiHASC) consensus guideline. THE LANCET. RHEUMATOLOGY 2024; 6:e51-e62. [PMID: 38258680 DOI: 10.1016/s2665-9913(23)00273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 01/24/2024]
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome characterised by persistently activated cytotoxic lymphocytes and macrophages, which, if untreated, leads to multiorgan dysfunction and death. HLH should be considered in any acutely unwell patient not responding to treatment as expected, with prompt assessment to look for what we term the three Fs-fever, falling blood counts, and raised ferritin. Worldwide, awareness of HLH and access to expert management remain inequitable. Terminology is not standardised, classification criteria are validated in specific patient groups only, and some guidelines rely on specialised and somewhat inaccessible tests. The consensus guideline described in this Health Policy was produced by a self-nominated working group from the UK network Hyperinflammation and HLH Across Speciality Collaboration (HiHASC), a multidisciplinary group of clinicians experienced in managing people with HLH. Combining literature review and experience gained from looking after patients with HLH, it provides a practical, structured approach for all health-care teams managing adult (>16 years) patients with possible HLH. The focus is on early recognition and diagnosis of HLH and parallel identification of the underlying cause. To ensure wide applicability, the use of inexpensive, readily available tests is prioritised, but the role of specialist investigations and their interpretation is also addressed.
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Affiliation(s)
- Miriam F Cox
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Strachan Mackenzie
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ryan Low
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Brown
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emilie Sanchez
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling Carr
- Centre for Neuromuscular Diseases, National hospital of Neurology and Neurosurgery, London, UK
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Bishton
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Duncombe
- Department of Haematology, University Hospital Southampton, Southampton, UK
| | - Akpabio Akpabio
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | - Fang En Sin
- Department of Rheumatology, North Bristol NHS Trust, UK
| | - Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Akhila Kavirayani
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ethan S Sen
- Department of Paediatric Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vanessa Quick
- Department of Rheumatology, Bedfordshire Hospitals NHS Trust, Luton, UK
| | - Gurdeep S Dulay
- Department of Rheumatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sam Clark
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kris Bauchmuller
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel S Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jessica J Manson
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
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2
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Misleading Positive Serology for Cat Scratch Disease Following Administration of Intravenous Immunoglobulin. Pathogens 2022; 11:pathogens11020177. [PMID: 35215121 PMCID: PMC8876604 DOI: 10.3390/pathogens11020177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/01/2023] Open
Abstract
Cat scratch disease (CSD), caused by Bartonella henselae, usually presents as regional lymphadenopathy/lymphadenitis, known as typical CSD or as atypical CSD, which includes, among others, neurological manifestations. Serology for anti-B. henselae IgG antibodies is the most commonly used diagnostic tests for CSD. Intravenous immunoglobulin (IVIG) is given for an increasing number of medical conditions and may cause interference with serological testing. We report six patients with neurological manifestations and two patients with Kawasaki disease mimicking typical CSD, mistakenly diagnosed as CSD due to false-positive serology following IVIG therapy. Bartonella IgG serology was positive one to six days after IVIG administration and reverted to negative in seven of eight patients or significantly decreased (1 patient) ≤30 days later. In patients with CSD, IgG titers remained essentially unchanged 15–78 days after the positive serum sample. An additional eight patients treated with IVIG for various conditions were evaluated prospectively. All were seronegative one day pre-IVIG infusion, five patients demonstrated an increase in the IgG titers one to three days after IVIG administration, one interpreted as positive and four as intermediate, whereas three patients remained seronegative, suggesting that false seropositivity after IVIG therapy may not occur in all patients. Treatment with IVIG can result in false-positive serology for B. henselae. Increased awareness to the misleading impact of IVIG is warranted to avoid misinterpretation. Repeat testing can distinguish between true and false serology. Preserving serum samples prior to IVIG administration is suggested.
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3
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Yasuda N, Nishikawa M, Shimosaka H, Ono Y, Yatomi Y. Effect of administration of immunoglobulin preparations on the results of tests for autoantibodies. Mod Rheumatol 2021; 32:946-952. [PMID: 34918126 DOI: 10.1093/mr/roab085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/06/2021] [Accepted: 09/27/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES We encountered the case in whom the results of autoantibodies tests became transiently positive after high-dose immunoglobulin therapy and investigated the effect of administration of these preparations on autoantibodies tests in subjects with autoimmune diseases who had received high-dose immunoglobulin therapy. METHODS We measured the autoantibodies in residual serum samples after routine clinical testing from eight subjects with autoimmune diseases who had received high-dose immunoglobulin therapy. We also measured the autoantibodies in available immunoglobulin preparations. RESULTS Tests for autoantibodies conducted before and after immunoglobulin therapy revealed a positive conversion of the results for anti-Sjogren's syndrome antigen A (SS-A) antibody, anti-glutamic acid decarboxylase (GAD) antibody, anti-thyroglobulin (Tg) antibody, and anti-thyroid peroxidase (TPO) antibody. In five cases in which changes in the antibody titres of anti-SS-A antibody after the high-dose immunoglobulin administration, it was found that the titres decreased by about 50% from 10 to 20 days after and the test result became negative 25- 30 days later. CONCLUSIONS In patients receiving high-dose immunoglobulin therapy, there appears to be a high likelihood of positive conversion of tests for anti-SS-A antibody, GAD antibody, Tg antibody, and TPO antibody after the treatment, so that cautious interpretation of the results is of importance.
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Affiliation(s)
- Naomi Yasuda
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Masako Nishikawa
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Hironori Shimosaka
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshikazu Ono
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan.,Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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4
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De l'Étoile-Morel S, Schweitzer L, Lefebvre MA. False-Positive Syphilis Serologies in a Woman Receiving Intravenous Immunoglobulin. Am J Med 2021; 134:e524-e525. [PMID: 33989602 DOI: 10.1016/j.amjmed.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Marie-Astrid Lefebvre
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Detection of Antibodies Against Human Leukocyte Antigen Class II in the Sera of Patients Receiving Intravenous Immunoglobulin. Transplant Direct 2021; 7:e697. [PMID: 34036167 PMCID: PMC8133174 DOI: 10.1097/txd.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. IVIG is occasionally used for preventing and treating severe infections of patients who are to undergo transplantation. Administration of IVIG, which includes high-titer antibodies (Abs) against HLA class I and II, might have a substantial influence on the HLA Ab test results of these patients. However, this issue has remained unreported.
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6
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False-positive Aspergillus galactomannan immunoassays associated with intravenous human immunoglobulin administration. Clin Microbiol Infect 2020; 26:1555.e9-1555.e14. [DOI: 10.1016/j.cmi.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/20/2019] [Accepted: 02/01/2020] [Indexed: 01/10/2023]
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7
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Wu Y, Shi J, Tan Y, Zhao Y, Yu J, Lai X, Yang L, Huang H, Luo Y. A Novel Strategy for the Prevention of Hepatitis B Virus-Related Hepatitis Following Allogeneic Hematopoietic Stem Cell Transplantation from Hepatitis B Surface Antigen-Positive Donors. Biol Blood Marrow Transplant 2020; 26:1719-1728. [DOI: 10.1016/j.bbmt.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/19/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
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8
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Dysart C, Rozenberg-Ben-Dror K, Sales M. Assessing Hepatitis B Reactivation Risk With Rituximab and Recent Intravenous Immunoglobulin Therapy. Open Forum Infect Dis 2020; 7:ofaa080. [PMID: 32211447 DOI: 10.1093/ofid/ofaa080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/27/2020] [Indexed: 12/20/2022] Open
Abstract
Hepatitis B reactivation (HBR) is a complication of immunosuppression associated with significant morbidity and mortality. To further complicate interpretation of hepatitis B serologies, false positivity can occur in patients with recent intravenous immunoglobulin exposure. This scenario is not well recognized and may lead to inappropriate prescribing of HBR prophylaxis.
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Affiliation(s)
- Claire Dysart
- Department of Veterans Affairs, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA
| | | | - Mariscelle Sales
- Department of Veterans Affairs Pharmacy Benefits Management Services and Center for Medication Safety (VA MedSAFE), Hines, Illinois, USA
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9
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Hanson KE, Gabriel N, Mchardy I, Hoffmann W, Cohen SH, Couturier MR, Thompson GR. Impact of IVIG therapy on serologic testing for infectious diseases. Diagn Microbiol Infect Dis 2019; 96:114952. [PMID: 31787407 DOI: 10.1016/j.diagmicrobio.2019.114952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
Intravenous immunoglobulin (IVIG) is used to treat an increasing number of conditions. The anti-inflammatory and immunomodulatory effects of IVIG can be life-saving; however, recent administration may complicate evaluation for infection. To assess the impact of IVIG therapy on a variety of common viral, bacterial, fungal, and parasitic serologies we prospectively evaluated serologic changes pre- and post-IVIG infusion in 7 participants. The number of new antibody detections ranging from 2 to 5. New detections included positivity for Epstein-Barr virus early D antigen, herpes simplex virus, West Nile virus, cytomegalovirus, and the endemic mycoses Histoplasma and Coccidioides. The greatest number of newly positive serologies was observed in subjects receiving cumulative doses of IVIG in excess of 100 g. Our results illustrate the difficulty in serologic interpretation following IVIG therapy and suggest a dose-response to new positive results. These findings may be a helpful resource to clinicians facing similar circumstances.
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Affiliation(s)
| | - Nielsen Gabriel
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Davis, CA, USA
| | - Ian Mchardy
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, CA, USA
| | - Wesley Hoffmann
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Davis, CA, USA
| | - Stuart H Cohen
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Davis, CA, USA
| | - Marc Roger Couturier
- University of Utah School of Medicine, Salt Lake City, UT, USA; Associated Regional and University Pathologists (ARUP), Salt Lake City, UT, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Davis, CA, USA; Department of Medical Microbiology and Immunology, University of California-Davis, Davis, CA, USA.
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10
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King C, Sutton-Fitzpatrick U, Houlihan J. Transient derangements in Hepatitis B serology in patients post-intravenous immunoglobulin therapy-a case-based review. Ir J Med Sci 2019; 189:617-620. [PMID: 31643027 DOI: 10.1007/s11845-019-02115-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/25/2019] [Indexed: 11/24/2022]
Abstract
Intravenous immunoglobulin (IVIg) is a commonly utilized therapy in multiple medical subspecialities, indicated for the management of various primary and secondary immunodeficiency states and autoimmune and inflammatory conditions. A lack of awareness exists among clinicians regarding the serological downstream effects of its use. An observed phenomenon post-IVIg is the passive transfer of antibodies from the product which can lead to transiently positive hepatitis B serology in recipients. When confounding viral serology is encountered, there is a risk to patients of treatment delays and mismanagement. Three patients encountered in the hematology department of a tertiary referral hospital developed spurious hepatitis B serology after administration of IVIg, whose cases are briefly outlined here. These cases highlight the need for routine pre-treatment viral screening and emphasize the importance of clinicians recognizing such potentially confounding results. This is of particular relevance to the sizeable subset of hematology patients who are planned for future immunomodulatory treatment (such as rituximab), where previous hepatitis B infection can often be a barrier to timely treatment.
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11
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Van der Bij AK, Pruissen DMO, Sankatsing SUC, van Houte AJ. Intravenous immunoglobulin remain a source of bias in the interpretation of infectious disease serology among clinicians. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 53:1042-1043. [PMID: 31606372 DOI: 10.1016/j.jmii.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/10/2019] [Accepted: 08/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
- A K Van der Bij
- Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the Netherlands.
| | - D M O Pruissen
- Department of Neurology, Diakonessenhuis, Utrecht, the Netherlands
| | - S U C Sankatsing
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | - A J van Houte
- Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the Netherlands
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12
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den Hoed-Krijnen AWJ, Smak Gregoor PJH. False-positive hepatitis B test results after intravenous immunoglobulin therapy. Clin Kidney J 2019; 12:463. [PMID: 31198550 PMCID: PMC6544086 DOI: 10.1093/ckj/sfz035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Indexed: 12/03/2022] Open
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13
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Prokopchuk-Gauk O, Khan AS, Misskey S, Lyon ME, Lyon AW. Transient hepatitis B immunity passively acquired from transfusion of packed red blood cells. Transfus Med 2018; 28:462-464. [PMID: 30311289 DOI: 10.1111/tme.12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 08/10/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- O Prokopchuk-Gauk
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - A S Khan
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - S Misskey
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - M E Lyon
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - A W Lyon
- Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Hui EP. Immunoglobulin therapy and passive transfer of anti-HBc: too often forgotten. Lancet Haematol 2018; 5:e437-e438. [DOI: 10.1016/s2352-3026(18)30158-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 11/26/2022]
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15
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Lo SY, Saifee NH, Greene DN. An Abrupt Hepatitis B Seroconversion. Clin Chem 2018; 62:1414-5. [PMID: 27683596 DOI: 10.1373/clinchem.2016.255299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/11/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Sheng-Ying Lo
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Nabiha Huq Saifee
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA.
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16
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Kiely P, Hoad VC, Wood EM. False positive viral marker results in blood donors and their unintended consequences. Vox Sang 2018; 113:530-539. [PMID: 29974475 DOI: 10.1111/vox.12675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 12/15/2022]
Abstract
False positive (FP) viral marker results in blood donors continue to pose many challenges. Informing donors of FP results and subsequent deferral can result in stress and anxiety for donors and additional complexity and workload for blood services. Donor management strategies need to balance the requirement to minimise donor anxiety and inconvenience while maintaining sufficiency of supply. Decisions about how and when to inform donors of FP results and determine deferral periods can be difficult as FP results, while often transitory, can take up to several years to resolve. Additional complexities include the interpretation of indeterminate serological confirmatory testing without detectable viral RNA or non-discriminated NAT results with concomitant anti-HBc reactivity - both may be due to FP results, but the former may also represent past infection and the later may represent occult hepatitis B infection. In this review we discuss strategies to minimise indeterminate serological confirmatory results, possible donor deferral policies and the impact on donors when notified of FP results. We also provide some new data from Australia that address the challenge of interpreting non-discriminated NAT results with concomitant anti-HBc reactivity. Ultimately, the challenge is for each blood service to develop appropriate strategies for donor management, taking into account local information and requirements.
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Affiliation(s)
- Philip Kiely
- Australian Red Cross Blood Service, Melbourne, Victoria, Australia
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Veronica C Hoad
- Australian Red Cross Blood Service, Perth, Western Australia, Australia
| | - Erica M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Guo Y, Tian X, Wang X, Xiao Z. Adverse Effects of Immunoglobulin Therapy. Front Immunol 2018; 9:1299. [PMID: 29951056 PMCID: PMC6008653 DOI: 10.3389/fimmu.2018.01299] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/24/2018] [Indexed: 01/09/2023] Open
Abstract
Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported. The majority of these events, such as flushing, headache, malaise, fever, chills, fatigue and lethargy, are transient and mild. However, some rare side effects, including renal impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury (TRALI), are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis.
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Affiliation(s)
- Yi Guo
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xin Tian
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
| | - Xuefeng Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, China
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Chen X. Misleading Hepatitis B Serology Following Rho (D) Immune Globulin (Human) Injection and Influenza Vaccine. Clin Pract 2018; 8:1037. [PMID: 29657700 PMCID: PMC5890088 DOI: 10.4081/cp.2018.1037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/26/2018] [Indexed: 11/23/2022] Open
Abstract
Having a hepatitis B surface antibody (HBsAb) titre of more than 10 mIU/mL after hepatitis B vaccination is generally considered to confer immunity to hepatitis B. This case report discusses an unusual case of a false positive hepatitis B core total antibody (HBcAb) following administration of either Rho (D) immune globulin (Human) injection or influenza vaccine in a patriuent who was previously immunised against hepatitis B.
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19
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Tavakolpour S. The role of intravenous immunoglobulin in treatment of mucous membrane pemphigoid: A review of literature. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2016; 21:37. [PMID: 27904583 PMCID: PMC5122191 DOI: 10.4103/1735-1995.183992] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/27/2016] [Accepted: 02/23/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is considered an autoimmune blistering disease that predominantly affects mucous membranes. Various treatments are available for controlling the diseases, but not all of them may respond. MATERIALS AND METHODS PubMed and Google Scholar were searched for all the associated studies until 2015, using the keywords such as "cicatricial pemphigoid" or "ocular pemphigoid" or "mucous membrane pemphigoid" or "MMP" and "intravenous immunoglobulin" or "IVIg" to find all the relevant studies. The last search update was for September 2, 2015. Among the searched items, only English studies were included in the review. RESULTS After excluding nonrelevant studies, 13 studies with a total number of seventy patients with MMP who were under treatment with IVIg were analyzed. The 65 patients responded completely, one did not respond, two had partially responded, and the remaining two patients stopped IVIg therapy, which resulted in ocular cicatricial pemphigoid progression. Majority of the studies reported mild adverse effects while two of them did not report any unwanted side effect. The most common side effect was headache, followed by nausea. Most of the patients who had a cessation of IVIg therapy before achieving clinical remission experienced the disease progression. CONCLUSION Overall, it can be concluded that IVIg therapy was very helpful in treatment of MMP patients who did not respond to conventional therapy or stopped using them for various side effects. Adverse effects associated with IVIg therapy were considerably lower than conventional therapy that can lead toward treatment with this agent in patients who suffer from severe side effects.
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Affiliation(s)
- Soheil Tavakolpour
- Department of Dermatology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Thibault V, Pinte L, Vergez J, Leger JM, Liou A. Too Often Forgotten: Passive Transfer of Antibodies. Clin Infect Dis 2016; 63:709-10. [PMID: 27208043 DOI: 10.1093/cid/ciw337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/08/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Laëtitia Pinte
- Department of Virology, CERVI Hôpitaux Universitaires La Pitié Salpêtrière
| | - Julie Vergez
- Department of Virology, CERVI Hôpitaux Universitaires La Pitié Salpêtrière
| | - Jean-Marc Leger
- Centre de Référence Maladies Neuromusculaires Bâtiment Babinski
| | - Amélie Liou
- Department of Pharmacy, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
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Ramsay I, Gorton RL, Patel M, Workman S, Symes A, Haque T, Irish D, Seneviratne SL, Burns SO, Wey E, Lowe DM. Transmission of Hepatitis B Core Antibody and Galactomannan Enzyme Immunoassay Positivity via Immunoglobulin Products: A Comprehensive Analysis. Clin Infect Dis 2016; 63:57-63. [PMID: 27076567 DOI: 10.1093/cid/ciw222] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 04/03/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Therapeutic immunoglobulins are used as replacement or immunomodulatory therapy, but can transmit clinically important molecules. We investigated hepatitis B virus (HBV) antibodies and galactomannan enzyme immunoassay (GM-EIA) positivity. Detection of HBV core antibody may prompt antiviral prophylaxis when commencing therapy such as rituximab; a positive GM-EIA result prompts investigation or treatment for invasive fungal disease. METHODS We performed a cross-sectional analysis of HBV serology in 80 patients established (>6 months) on immunoglobulin therapy; prospective analysis of HBV serology in 16 patients commencing intravenous immunoglobulin (IVIG); and pre- and post-infusion analysis of GM-EIA in 37 patients receiving IVIG. RESULTS Pre-IVIG, 9 of 80 patients tested positive for HBV surface antibody and 1 of 80 tested equivocal for HBV core antibody. On IVIG, 79 of 79 tested positive for surface antibody, 37 of 80 tested positive for core antibody, and 10 of 80 tested equivocal for core antibody. There were significant differences by product, but among patients receiving products that appear to transmit core antibody, negative results correlated with lower surface antibody titers and longer time since infusion, suggesting a simple concentration effect. There was a progressive increase with each infusion in the percentage of patients testing positive for HBV core antibody among patients newly commencing IVIG. Some patients "seroreverted" to negative during therapy. Certain IVIG products tested positive for GM-EIA and there were rises in index values in corresponding patient samples from pre- to post-infusion. Overall, 5 of 37 patient samples pre-infusion and 15 of 37 samples post-infusion tested positive for GM-EIA. CONCLUSIONS HBV antibodies and GM-EIA positivity are common in patients receiving IVIG and confound diagnostic results.
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Affiliation(s)
- Isobel Ramsay
- Department of Virology, Royal Free London National Health Service (NHS) Foundation Trust.,Department of Microbiology, Addenbrooke's Hospital NHS Foundation Trust, Cambridge
| | | | - Mauli Patel
- Department of Virology, Health Services Laboratory, Royal Free Hospital
| | - Sarita Workman
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust
| | - Andrew Symes
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust
| | - Tanzina Haque
- Department of Virology, Royal Free London National Health Service (NHS) Foundation Trust
| | - Dianne Irish
- Department of Virology, Royal Free London National Health Service (NHS) Foundation Trust
| | - Suranjith L Seneviratne
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust.,Institute of Immunity and Transplantation, University College London, Royal Free Campus
| | - Siobhan O Burns
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust.,Institute of Immunity and Transplantation, University College London, Royal Free Campus
| | - Emmanuel Wey
- Department of Microbiology, Royal Free London NHS Foundation Trust, United Kingdom
| | - David M Lowe
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust.,Institute of Immunity and Transplantation, University College London, Royal Free Campus
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22
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Nomura H, Honda H, Egami S, Yokoyama T, Fujimoto A, Ishikawa M, Sugiura M. False-positive serology following intravenous immunoglobulin and plasma exchange through transfusion of fresh frozen plasma in a patient with pemphigus vulgaris. J Dermatol 2015; 42:398-400. [PMID: 25656913 DOI: 10.1111/1346-8138.12785] [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: 09/04/2014] [Accepted: 12/17/2014] [Indexed: 12/01/2022]
Abstract
Intravenous immunoglobulin therapy and plasma exchange through transfusion of fresh frozen plasma are therapeutic options for patients with refractory pemphigus vulgaris. Passive acquisition of various clinically important antibodies through these therapies can occur, leading to false serology and negatively affecting patients' clinical care. It is recommended that dermatologists recognize the possibility of these phenomena and interpret them appropriately. Here, we report false-positive serology following intravenous immunoglobulin therapy and plasma exchange through transfusion of fresh frozen plasma in a patient with refractory pemphigus vulgaris. We also discuss the measure for misinterpretation and unnecessary clinical intervention.
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Affiliation(s)
- Hisashi Nomura
- Department of Dermatology, Shizuoka Municipal Shimizu Hospital, Shizuoka, Japan
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