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Kim Y, Ku J, Jung Y, Lim Y, Ji M, Park Y, Cho H, Choi K, Park J. Evaluation of haematological parameters in haemolytic anaemia caused by tick-borne pathogens in grazing cattle. Vet Med Sci 2024; 10:e1434. [PMID: 38567942 PMCID: PMC10989275 DOI: 10.1002/vms3.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/07/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND No tick-borne pathogens (TBPs) causing haemolytic anaemia in cattle have been reported, except Theileria orientalis and complete blood count (CBC) profile is the only haematological parameter to determine the severity of regenerative haemolytic anaemia. OBJECTIVES To identify the causative agents of TBP-induced haemolytic anaemia and determine haematological parameters that indicate haemolytic anaemia in grazing cattle. METHODS Eighty-two Korean indigenous cattle (Hanwoo) were divided into two groups: grazing (n = 67) and indoor (n = 15) groups. CBC and serum biochemistry were performed. PCR was conducted using whole blood-extracted DNA to investigate the prevalence of TBPs. RESULTS TBP-induced haemolytic anaemia was observed in the grazing group. In grazing cattle, co-infection (43.3%, 29/67) was most frequently detected, followed by T. orientalis (37.6%, 25/67) and Anaplasma phagocytophilum infections (1.5%, 1/67). In indoor cattle, only co-infection (20%, 3/15) was identified. Grazing cattle exhibited regenerative haemolytic anaemia with marked monocytosis, mild neutropenia, and thrombocytopenia. According to grazing frequency, the 1st-time grazing group had more severe anaemia than the 2nd-time grazing group. Elevations in indirect bilirubin and L-lactate due to haemolytic anaemia were identified, and correlations with the respective markers were determined in co-infected grazing cattle. CONCLUSIONS Quantitative evaluation of haematocrit, mean corpuscular volume, and reticulocytes (markers of regenerative haemolytic anaemia in cattle) was performed for the first time. Our results show that, in addition to T. orientalis, A. phagocytophilum is strongly associated with anaemia. The correlation between haemolytic anaemia severity and haematological parameters (indirect bilirubin, reticulocytes, and L-lactate) was confirmed.
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Affiliation(s)
- Youngjun Kim
- Department of Veterinary Internal MedicineCollege of Veterinary MedicineJeonbuk UniversityIksanRepublic of Korea
- Department of Animal Hospital, Hanwoo (Korean Indigenous Cattle) Genetic Improvement CenterNational Agricultural Cooperative FederationSeosanRepublic of Korea
| | - Ji‐Young Ku
- Department of Veterinary Internal MedicineCollege of Veterinary MedicineJeonbuk UniversityIksanRepublic of Korea
| | - Youngwoo Jung
- Department of Veterinary Internal MedicineCollege of Veterinary MedicineJeonbuk UniversityIksanRepublic of Korea
| | - Young‐Hwan Lim
- Department of Animal Hospital, Hanwoo (Korean Indigenous Cattle) Genetic Improvement CenterNational Agricultural Cooperative FederationSeosanRepublic of Korea
| | - Min‐Jeong Ji
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Yu‐Jin Park
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Hyung‐Chul Cho
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Kyoung‐Seong Choi
- Department of Animal Science and Biotechnology, College of Ecology and Environmental ScienceKyungpook National UniversitySangjuRepublic of Korea
| | - Jinho Park
- Department of Animal Hospital, Hanwoo (Korean Indigenous Cattle) Genetic Improvement CenterNational Agricultural Cooperative FederationSeosanRepublic of Korea
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Ghimirey N, Vo PU, Dibb J, Hatch J, Mahesh S. CRE24-050: Microangiopathic Hemolytic Anemia as the Presenting Manifestation of Metastatic Breast Cancer. J Natl Compr Canc Netw 2024; 22:CRE24-050. [PMID: 38579788 DOI: 10.6004/jnccn.2023.7324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
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Kato H, Kato N, Ouchi T, Higashigawa T, Bessho S, Shomura Y, Ichikawa Y, Sakuma H. Hemolytic Anemia Caused by Graft Kinking Following Ascending Aortic Replacement: Endovascular Treatment With a Palmaz XL Stent. Vasc Endovascular Surg 2024; 58:457-460. [PMID: 38019846 DOI: 10.1177/15385744231219478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
A 66-year-old man presented with hemolytic anemia, which required frequent blood transfusion, 6 months after surgical repair of an ascending aortic pseudoaneurysm. Hemolysis was attributed to luminal stenosis caused by graft kinking by laboratory test, CT and four-dimensional magnetic resonance imaging. First, an Excluder cuff was placed at the stenotic site under rapid pacing, but it migrated distally. Thereafter a Palmaz XL stent was placed at the stenotic site, which led to resolution of anemia. In this case, a Palmaz XL stent was successfully used to treat hemolytic anemia caused by graft kinking following ascending aortic surgery.
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Affiliation(s)
- Hiroaki Kato
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Takafumi Ouchi
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Saki Bessho
- Department of Cardiovascular Surgery, Mie University Hospital, Tsu, Japan
| | - Yu Shomura
- Department of Cardiovascular Surgery, Mie University Hospital, Tsu, Japan
| | | | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
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4
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Nakamura K, Taniguchi T, Furukawa Y. Haemolytic anaemia after transcatheter aortic valve replacement. Eur Heart J 2024; 45:1181. [PMID: 38240597 DOI: 10.1093/eurheartj/ehae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Kanna Nakamura
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-2-1 Mitatojimaminamimiachi, Chuo-ku, Kobe 650-0047, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-2-1 Mitatojimaminamimiachi, Chuo-ku, Kobe 650-0047, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-2-1 Mitatojimaminamimiachi, Chuo-ku, Kobe 650-0047, Japan
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5
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Xie Z, Li W, Chen X. Pyrites: A Case of Severe Hemolytic Anemia. J Pediatr Hematol Oncol 2024; 46:175-176. [PMID: 38150636 PMCID: PMC10956651 DOI: 10.1097/mph.0000000000002806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Zulin Xie
- Department of Laboratory Medicine, Liuzhou People’s Hospital, Liuzhou, Guangxi
| | - Wei Li
- Department of Laboratory Medicine, Liuzhou People’s Hospital, Liuzhou, Guangxi
| | - Xueyan Chen
- Clinical Laboratory, Department of Clinical Laboratory, People’s Hospital of Longhua Shenzhen, Shenzhen, China
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6
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Imamura Y, Kitamura H, Aichi C, Fukumoto Y, Tamaki M, Okawa Y. [A Successful Surgical Treatment of Hemolytic Anemia Caused by Aortic Valve Perivalvular Leakage and Severely Kinked Elephant Trunk:Report of a Case]. Kyobu Geka 2024; 77:306-309. [PMID: 38644179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Both perivalvular leakage and kinked prosthetic graft may cause hemolysis. A 72-year-old man was refereed to our hospital because of hemolytic anemia. He has past histories of total aortic arch replacement and repeat aortic valve replacement for aortic aneurysm and prosthetic valve endocarditis. Pre-operative examinations demonstrated aortic valve perivalvular leakage and severe graft kinking of the elephant trunk. Repeat aortic valve replacement and axillo-femoral bypass were performed successfully. Hemolysis got better after the operation and the patient discharged home in stable condition.
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Affiliation(s)
- Yusuke Imamura
- Division of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
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Leisring J, Brodsky SV, Parikh SV. Clinical Evaluation and Management of Thrombotic Microangiopathy. Arthritis Rheumatol 2024; 76:153-165. [PMID: 37610060 DOI: 10.1002/art.42681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/17/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Thrombotic microangiopathy (TMA) refers to a diverse group of diseases that share clinical and histopathologic features. TMA is clinically characterized by microangiopathic hemolytic anemia, consumptive thrombocytopenia, and organ injury that stems from endothelial damage and vascular occlusion. There are several disease states with distinct pathophysiological mechanisms that manifest as TMA. These conditions are associated with significant morbidity and mortality and require urgent recognition and treatment. Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome are traditionally considered to be primary forms of TMA, but TMA more commonly occurs in association with a coexisting condition such as infection, pregnancy, autoimmune disease, or malignant hypertension, among others. Determining the cause of TMA is a diagnostic challenge because of limited availability of disease-specific testing. However, identifying the underlying etiology is imperative as treatment strategies differ. Our understanding of the conditions that cause TMA is evolving. Recent advances have led to improved comprehension of the varying pathogenic mechanisms that drive TMA. Development of targeted therapeutics has resulted in significant improvements in patient outcomes. In this article, we review the pathogenesis and clinical features of the different TMA-causing conditions. We outline a practical approach to diagnosis and management and discuss empiric and disease-specific treatment strategies.
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Affiliation(s)
- Joshua Leisring
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Samir V Parikh
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Dofuku M, Tamura D, Mizobe M, Kurane K, Hayashi Y, Kimura H, Shimada A. Severe hemolytic anemia in a glucose-6-phosphate dehydrogenase-deficient child with COVID-19. Pediatr Int 2024; 66:e15717. [PMID: 38217100 DOI: 10.1111/ped.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Mika Dofuku
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Daisuke Tamura
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Marina Mizobe
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Koyuru Kurane
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Yuriko Hayashi
- Department of Health Science, Gunma Paz University Graduate School, Takasaki, Gunma, Japan
| | - Hirokazu Kimura
- Department of Health Science, Gunma Paz University Graduate School, Takasaki, Gunma, Japan
| | - Akira Shimada
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
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9
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Wills J, Horenstein M, Kim A, Silva MA, Dima L. Mitapivat: A Quinolone Sulfonamide to Manage Hemolytic Anemia in Adults With Pyruvate Kinase Deficiency. Am J Ther 2023; 30:e433-e438. [PMID: 37713687 DOI: 10.1097/mjt.0000000000001663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND Pyruvate kinase (PK) deficiency is a rare enzyme-linked glycolytic defect resulting in mild-to-severe chronic persistent erythrocyte hemolysis. The disease is an autosomal recessive trait caused by mutations in the PK liver and red blood cell gene characterized by insufficient erythrocyte PK activity. PK deficiency is most diagnosed in persons of northern European descent and managed with packed red blood cell transfusions, chelation, and splenectomy with cholecystectomy. Mitapivat is the first approved therapy indicated for hemolytic anemia in adults with PK deficiency with the potential for delaying splenectomy in mild-moderate disease. MECHANISM OF ACTION, PHARMACODYNAMICS, AND PHARMACOKINETICS Mitapivat is a PK activator that acts by allosterically binding to the PK tetramer and increases PK activity. The red blood cell form of PK is mutated in PK deficiency, which leads to reduced adenosine triphosphate, shortened red blood cell lifespan, and chronic hemolysis. The half-life of elimination is 3-5 hours, with 73% bioavailability, 98% plasma protein binding, and a median duration of response of 7 months. CLINICAL TRIALS Mitapivat has been investigated through various clinical trials for different therapeutic indications. Pivotal trials that serve the primary focus throughout this article are ACTIVATE, ACTIVATE-T, and RISE. ACTIVATE is a phase 3, randomized, double-blind, placebo-controlled study that evaluated the efficacy and safety of mitapivat in adult patients who were not receiving regular blood transfusions. Contrarily, ACTIVATE-T explored the safety and efficacy of mitapivat in adults with PK deficiency who received regular blood transfusions. Both trials demonstrated favorable use of mitapivat in PK deficiency. Focusing on another indication, the ongoing RISE trial investigates the optimal dosage of mitapivat in sickle cell disease. THERAPEUTIC ADVANCE Mitapivat is an appropriate treatment for adults with PK deficiency requiring transfusions and may be considered for patients with symptomatic anemia who do not require transfusions and/or PK deficiency with compensated hemolysis without overt anemia.
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Affiliation(s)
- Josef Wills
- Global Scientific Communications Rare Blood Disorders, Sanofi, Cambridge, MA
| | | | - Alicia Kim
- Global Scientific Communications Rare Blood Disorders, Sanofi, Cambridge, MA
| | - Matthew A Silva
- Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy, Worcester, MA
| | - Lorena Dima
- Transilvania University, Faculty of Medicine, Department of Fundamental Disciplines and Clinical Prevention, Brasov, Romania
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10
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Yeom GE, Lim SH, Kim JH, Ahn YH, Kim H, Ha J, Kim HY, Kang HG. Gastrointestinal involvement of passenger lymphocyte syndrome followed by minor ABO-incompatible renal transplantation: A case report. Pediatr Transplant 2023; 27:e14556. [PMID: 37300335 DOI: 10.1111/petr.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/02/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND People with group O blood are considered universal organ donors compatible with any other blood group. However, in the case of minor ABO-incompatible transplantation, immune-mediated hemolysis may occur due to concomitant transfer of donor B lymphocytes together with the allograft. These passenger lymphocytes can produce antibodies in the recipients erythrocytes, causing hemolytic anemia known as passenger lymphocyte syndrome (PLS). METHODS A retrospective chart review was performed. RESULTS A 6-year-old boy (A+) underwent transplantation of a kidney from his father (O+). On postoperative day (POD) 6, the patient developed fever with no explainable causes. On POD 11, he presented with abdominal pain, hematochezia, and severe diarrhea, with sudden hemolytic anemia. Since then, GI symptoms have continued. On POD 20, direct antiglobulin test (DAT) was positive, and the anti-A IgM/G titer was 2/32. The results of the anti-A antibody elution test were strongly positive (3+). These findings highly suggested PLS. On the same day, the GI symptoms suddenly worsened, and laboratory findings showed hemolysis and thrombocytopenia with disseminated intravascular coagulation (DIC). Abdominal computed tomography (CT) scans suggested ischemic colitis of venous origin, and the patient underwent segmental colectomy with ileostomy formation on POD 23. To remove the anti-A antibodies, the patient underwent therapeutic plasma exchange (TPE) five times until the DAT and anti-A elution test were negative. CONCLUSIONS We report a case of gastrointestinal involvement of PLS that occurred after minor ABO-incompatible kidney transplantation. This is the first report of ischemic colitis as an atypical manifestation of PLS.
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Affiliation(s)
- Gyeong Eun Yeom
- Departments of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Seon Hee Lim
- Department of Pediatrics, Pusan National University Children's Hospital and School of Medicine, Yangsan, Republic of Korea
| | - Ji Hyun Kim
- Departments of Pediatrics, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Yo Han Ahn
- Departments of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jongwon Ha
- The Transplantation Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Gyung Kang
- Departments of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
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11
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Risinger M, Kim PS, Rodriguez RX, Narvaez Rivas M, Setchell KDR, Zhang W, Kalfa TA. Hemolytic anemia and macrothrombocytopenia: A lipid problem? Am J Hematol 2023; 98:1335-1340. [PMID: 36974979 PMCID: PMC10523966 DOI: 10.1002/ajh.26916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Mary Risinger
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Phyllis S Kim
- Hematology and Medical Oncology Department, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Roberto X Rodriguez
- Hematology and Medical Oncology Department, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Monica Narvaez Rivas
- Division of Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kenneth D R Setchell
- Division of Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Wenying Zhang
- Genetics and Genomics Diagnostic Laboratory, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Theodosia A Kalfa
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Lee AI, Heidari P, Fenves AZ, Bardia A, Ta R. Case 8-2023: A 71-Year-Old Woman with Refractory Hemolytic Anemia. N Engl J Med 2023; 388:1032-1041. [PMID: 36920760 PMCID: PMC10133839 DOI: 10.1056/nejmcpc2211370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Alfred I Lee
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Pedram Heidari
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Andrew Z Fenves
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Aditya Bardia
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
| | - Robert Ta
- From the Department of Medicine, Yale School of Medicine, New Haven, CT (A.I.L.); and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Massachusetts General Hospital, and the Departments of Radiology (P.H.), Medicine (A.Z.F., A.B.), and Pathology (R.T.), Harvard Medical School - both in Boston
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Matsuoka T, Inui A, Yamabi H, Imanaka K. [Graft Kink with Hemolytic Anemia Caused by Enlargement of the Residual False Lumen in the Aortic Root:Report of a Case]. Kyobu Geka 2022; 75:951-954. [PMID: 36176256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 67-year-old male underwent ascending aortic replacement for Stanford type A acute aortic dissection four years ago. Residual false lumen in the aortic root and mild to moderate aortic regurgitation were noted postoperatively. Two and a half years later, he presented with hemolytic anemia and shortness of breath. Computed tomography (CT) revealed aneurysmal aortic root and severely kinked vascular prosthesis, and echocardiography showed severe aortic regurgitation. It was considered that the proximal residual false lumen gradually enlarged, and the graft was pushed up distally and kinked, resulting in hemolytic anemia. Surgical treatment was indicated because of deteriorating shortness of breath due to hemolytic anemia (Hb 6.7 g/dl, LDH 1,528 U/l) and aortic regurgitation. Aortic root replacement was successfully performed and hemolytic anemia improved immediately after surgery.
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Affiliation(s)
- Takahiro Matsuoka
- Department of Cardiovascular Surgery, Saitama Medical Center, Kawagoe, Japan
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Takei Y, Shibasaki I, Suzuki K, Miyazaki S, Hirota S, Ohashi H, Saito S, Fukuda H. Hemolytic anemia caused by an excessively kinked prosthetic graft after total arch replacement detected by 4-dimensional flow magnetic resonance imaging: A case report. Medicine (Baltimore) 2022; 101:e29617. [PMID: 35866824 PMCID: PMC9302348 DOI: 10.1097/md.0000000000029617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Hemolytic anemia is a rare postoperative complication of aortic surgery, which may be caused by an excessively kinked graft that causes abnormal blood flow. It has been reported that 4-dimensional flow magnetic resonance imaging (4D flow MRI) can identify abnormal flow. Herein, we report the guidance of 4D flow MRI in performing the revision procedure for a patient with hemolytic anemia by evaluating abnormal blood flow based on this method. PATIENT CONCERNS A 70-year-old woman presented with dizziness and fatigue. She had undergone total arch replacement with a frozen elephant trunk 5 years prior. We diagnosed hemolytic anemia caused by a kinked graft after total arch replacement. DIAGNOSIS Although computed tomography findings revealed 3 lesions of the kinked graft at the ascending portion and cervical branches, 4D flow MRI findings showed that only the kinked graft at the ascending portion caused hemolytic anemia due to an elevated viscous energy loss around it. INTERVENTION We performed surgery to remove the kinked section instead of revision surgery consisting of total arch replacement. OUTCOMES The patient's postoperative course was uneventful and there were no complications. Postoperative enhanced computed tomography findings showed that the repaired graft had an adequate length and smoothly curved shape. The 4D flow MRI findings revealed smooth flow in the ascending portion and decreased viscous energy loss. LESSONS Based on the 4D flow MRI findings, we adopted a less invasive approach, repairing only the ascending portion of the graft, instead of performing revision surgery comprising total arch replacement.
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Affiliation(s)
- Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Hospital, Mibu-Machi, Tochigi, Japan
- *Correspondence: Yusuke Takei, Department of Cardiac and Vascular Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi 321-0293, Japan (e-mail: )
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Hospital, Mibu-Machi, Tochigi, Japan
| | | | | | - Shotaro Hirota
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Hospital, Mibu-Machi, Tochigi, Japan
| | - Hirotaka Ohashi
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Hospital, Mibu-Machi, Tochigi, Japan
| | - Shunsuke Saito
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Hospital, Mibu-Machi, Tochigi, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Hospital, Mibu-Machi, Tochigi, Japan
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Abstract
COVID-19 is a global pandemic triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 entry point involves the interaction with angiotensin-converting enzyme 2 (ACE2) receptor, CD147, and erythrocyte Band3 protein. Hemolytic anemia has been linked to COVID-19 through induction of autoimmune hemolytic anemia (AIHA) caused by the formation of autoantibodies (auto-Abs) or directly through CD147 or erythrocyte Band3 protein-mediated erythrocyte injury. Here, we aim to provide a comprehensive view of the potential mechanisms contributing to hemolytic anemia during the SARS-CoV-2 infection. Taken together, data discussed here highlight that SARS-CoV-2 infection may lead to hemolytic anemia directly through cytopathic injury or indirectly through induction of auto-Abs. Thus, as SARS-CoV-2-induced hemolytic anemia is increasingly associated with COVID-19, early detection and management of this condition may prevent the poor prognostic outcomes in COVID-19 patients. Moreover, since hemolytic exacerbations may occur upon medicines for COVID-19 treatment and anti-SARS-CoV-2 vaccination, continued monitoring for complications is also required. Given that, intelligent nanosystems offer tools for broad-spectrum testing and early diagnosis of the infection, even at point-of-care sites.
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Affiliation(s)
- Hayder M. Al-kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, M.B.Ch.B, FRCP, Baghdad, Iraq
| | - Ali I. Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, M.B.Ch.B, FRCP, Baghdad, Iraq
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Department of Environmental Engineering, Florida Polytechnic University, Lakeland, FL 33805-8531 USA
| | - Małgorzata Kujawska
- Department of Toxicology, Faculty of Pharmacy, Poznan University of Medical Sciences, Dojazd 30, 60-631 Poznań, Poland
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, Al Beheira, Egypt
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16
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Barron K, Ramadas P, Grewal US. Hemolytic anemia in a patient with cirrhosis: Hiding in the smear! Eur J Intern Med 2022; 101:112-113. [PMID: 35346568 DOI: 10.1016/j.ejim.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kyle Barron
- Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Poornima Ramadas
- Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Udhayvir Singh Grewal
- Division of Internal Medicine, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States.
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17
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Arora N, Gulati P, Suri V, Bhalla A, Singh H. Hemolytic anemia in expanded dengue syndrome. QJM 2022; 115:103-104. [PMID: 34850225 DOI: 10.1093/qjmed/hcab298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Arora
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - P Gulati
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - V Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - H Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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18
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Suzuki T, Okamoto T, Kawai F, Okuyama S, Fukuda K. Hemolytic Anemia after Acute Hepatitis B Virus Infection: A Case Report and Systematic Review. Intern Med 2022; 61:481-488. [PMID: 34433718 PMCID: PMC8907784 DOI: 10.2169/internalmedicine.7690-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hemolytic anemia and pure red cell aplasia are rare hematological complications of hepatitis B virus infection. We herein report a 24-year-old man who was diagnosed with hemolytic anemia and possible transient pure red cell anemia eight weeks after a severe episode of acute hepatitis B virus infection. Rapid recovery was observed with conservative management. Hemoglobin returned to baseline within three months. As the clinical features of hemolytic anemia associated with hepatitis B virus have not yet been elucidated, we conducted a systematic review and present an analysis of the 20 reported cases, including our present case.
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Affiliation(s)
- Takahiro Suzuki
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Fujimi Kawai
- St. Luke's International University Library, Japan
| | - Shuhei Okuyama
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Japan
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19
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Isomura S, Ohno H, Yamaki F, Yamamoto H, Kasai E. [Delayed Hemolytic Transfusion Reaction after Mitral Valve Replacement:Report of a Case]. Kyobu Geka 2022; 75:111-113. [PMID: 35249086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We report a case of delayed hemolytic transfusion reaction (DHTR) after mitral valve replacement (MVR). A 67-year-old woman with a history of blood transfusion( BT) was admitted for MVR. Preoperative laboratory test proved to be negative for irregular antibodies except anti-Dia. She underwent MVR using a mechanical prosthesis and compatible blood products were transfused perioperatively. On post-operative day 13, she developed hemoglobinuria and anemia with elevated serum total bilirubin and lactic dehydrogenase levels. Transesophageal echocardiography showed trivial transvalvular leakage. Laboratory test successfuly identified another irregular antibody, anti-Jkb antibody. The patient had Jkb negative BT and did not need re-operation. Later, she recovered with no signs of hemolysis. Since anti-Jkb antibody gets undetectable within a few months, it is difficult to find out before surgery. As hemolysis following cardiac surgery is more commonly associated with prostheses and extracorporeal circulation than DHTR. Physicians should, however, be aware of this unusual complication especially in patients who underwent BT.
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Affiliation(s)
- Shogo Isomura
- Department of Cardiovascular Surgery, Nagano Chuo Hospital, Nagano, Japan
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20
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Affiliation(s)
- Ameet Patel
- Vanderbilt University Medical Center, Nashville, TN
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21
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Puccetti L, Bacchiarri F, Calzoni P, Santoni A, Bocchia M. A fatal unsuspected case of acquired A hemophilia. Misleading role of therapy with acetylsalicylic acid? Intern Emerg Med 2021; 16:2339-2340. [PMID: 34100213 PMCID: PMC8183321 DOI: 10.1007/s11739-021-02760-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Luca Puccetti
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy.
| | - Francesca Bacchiarri
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
| | - Paola Calzoni
- Coagulative Disorders Laboratory Unit, Santa Maria Alle Scotte University Teaching Hospital of Siena, Siena, Italy
| | - Adele Santoni
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
| | - Monica Bocchia
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
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22
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Shingu M, Ishimaru N, Ohnishi J, Mizuki S, Kanzawa Y, Kawano K, Nakajima T, Sano N, Kinami S. Hemolytic Anemia in a Patient with Subacute Bacterial Endocarditis by Cardiobacterium hominis. Intern Med 2021; 60:3489-3495. [PMID: 34024848 PMCID: PMC8627805 DOI: 10.2169/internalmedicine.6186-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hemolytic anemia is a rarely occurring manifestation of native valve infective endocarditis. We herein report an afebrile patient with hemolytic anemia caused by Cardiobacterium hominis endocarditis. A 60-year-old Japanese man had a history of aortic root replacement and the gradual onset of general fatigue. He had hemolytic anemia. Blood cultures detected C. hominis. A transthoracic echocardiogram showed aortic valve vegetation and periannular abscess with perforation of the non-coronary cusp. Intravascular hemolysis recovered after antimicrobial therapy, surgical removal of the vegetation and abscess, and aortic valve replacement. Subacute endocarditis should be considered if patients develop hemolytic anemia with signs of chronic inflammation without a fever.
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Affiliation(s)
- Motohiro Shingu
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Jun Ohnishi
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Shimpei Mizuki
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Kei Kawano
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Takahiro Nakajima
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Nobuya Sano
- Department of Pathology, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
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Topyildiz E, Edeer Karaca N, Bas I, Aykut A, Durmaz A, Guven Bilgin RB, Aksu G, Yilmaz Karapinar D, Kutukculer N. A Novel Homozygous TRNT1 Mutation in a Child With an Early Diagnosis of Common Variable Immunodeficiency Leading to Mild Hypogammaglobulinemia and Hemolytic Anemia. J Pediatr Hematol Oncol 2021; 43:e780-e784. [PMID: 33843817 DOI: 10.1097/mph.0000000000002101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/20/2020] [Indexed: 01/06/2023]
Abstract
Although sideroblastic anemias (SAs) may be associated with different etiologies, deterioration of mitochondrial heme biosynthesis in bone marrow erythroid cells is a general abnormality. Congenital SA associated with immunodeficiency, periodic fever, and developmental delay is because of loss-of-function mutations in the TRNT1 gene. We report a patient with a novel homozygous mutation in the TRNT1 gene presenting with anemia with siderocytes, hypogammaglobulinemia, hepatosplenomegaly, and brittle hair but without periodic fever or developmental delay. The patient was presented to emphasize the power of reverse phenotyping in the differential diagnosis of primary immunodeficiency patients with atypical features and to raise awareness for TRNT1 disease in case of coexistent SA and hypogammaglobulinemia.
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Affiliation(s)
| | | | | | - Ayca Aykut
- Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Asude Durmaz
- Medical Genetics, Ege University Faculty of Medicine, Izmir, Turkey
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24
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Covarelli C, Brugnano R, Pasquino S, Buoncristiani E, Del Sordo R, Sidoni A. [Relevance of an accurate microscopic examination of urinary sediment in a patient after mitral valve surgery]. G Ital Nefrol 2021; 38:38-03-2021-06. [PMID: 34169694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hemoglobinuria, clinically revealing as gross hematuria associated with anemia, increased hemolysis indices, acute kidney injury (AKI), can all be caused by mechanical intravascular hemolysis following mitral valve surgery. It can result from factors related to the surgical procedure or acquired later, such as paravalvular leak (PL), whose definite diagnosis is based on transesophageal echocardiography. We report the case of a patient who experienced macrohematuria and AKI, initially attributed to acute glomerulonephritis, two months after mitral valve surgery. Careful microscopic examination of the urinary sediment was a diriment diagnostic tool to differentiate acute renal failure caused by hemoglobinuria from hematuria in the course of acute glomerulonephritis, directing clinicians to investigate post-operative valvular dysfunction. From the literature review we can deduce that, notwithstanding new technologies in cardiac surgery, this rare form of AKI from intravascular hemolysis requires immediate nephrological attention and that the use of microscopic urinary sediment is decisive.
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Affiliation(s)
- Carla Covarelli
- S.C. di Anatomia e Istologia Patologica, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Rachele Brugnano
- Specialista in Nefrologia, membro della Società Italiana di Nefrologia, Perugia, Italy
| | - Stefano Pasquino
- S.C. di Cardiochirurgia, Ospedale Santa Maria della Misericordia Perugia, Italy
| | | | - Rachele Del Sordo
- S.C. di Anatomia e Istologia Patologica, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Angelo Sidoni
- S.C. di Anatomia e Istologia Patologica, Ospedale S. Maria della Misericordia, Perugia, Italy
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Barile-Fabris LA, Fragoso-Loyo H, Wojdyla D, Quintana R, Pons-Estel GJ, Catoggio LJ, García MA, Saurit V, Drenkard C, Bonfa E, Borba EF, Sato E, Tavares Brenol JC, Cavalcanti F, Da Silva NA, Lavras Costallat LT, Guibert Toledano M, Massardo L, Neira O, Cardiel MH, Amigo MC, García De La Torre I, Silveira LH, Acevedo Vásquez EM, Chacón-Diaz R, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA. Factors associated with neuropsychiatric involvement in Latin American patients with systemic lupus erythematosus. Lupus 2021; 30:1481-1491. [PMID: 34082589 DOI: 10.1177/09612033211020364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established. PURPOSE To identify disease and non-disease related factors associated with NP manifestations in early SLE. METHODS We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up. STATISTICAL METHODS Independent factors associated with NP involvement were identified using a multivariable Cox regression model. RESULTS Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282-2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335-2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085-5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074-5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130-2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441-0.934, p = 0.0206). CONCLUSIONS Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement.
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Affiliation(s)
| | - Hilda Fragoso-Loyo
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, México
| | | | - Rosana Quintana
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Guillermo J Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Luis J Catoggio
- Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Instituto Universitario Escuela de Medicina y Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - Mercedes A García
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Cristina Drenkard
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo SP, Brasil
| | - Eduardo F Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo SP, Brasil
| | - Emilia Sato
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paul, Brasil
| | - Joao C Tavares Brenol
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Fernando Cavalcanti
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brasil
| | - Nilzio A Da Silva
- Serviço de Reumatologia, Departamento de Clinica Medica, Facultad de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brasil
| | - Lilian T Lavras Costallat
- Departamento de Clínica Médica, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brasil
| | - Marlene Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico-Quirúrgicas (CIMEQ), La Habana, Cuba
| | - Loreto Massardo
- Facultad de Medicina y Ciencia, Centro de Biología Celular y Biomedicina, Universidad San Sebastián, Santiago, Chile
| | - Oscar Neira
- Sección de Reumatología, Hospital del Salvador, Universidad de Chile, Unidad de Reumatología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia, SC, Morelia, México
| | - Mary Carmen Amigo
- Servicio de Reumatología, Centro Médico ABC, Ciudad de México, México
| | | | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México
| | - Eduardo M Acevedo Vásquez
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Servicio de Reumatología. Clínica San Felipe, Jesús María, Lima, Perú
| | - Rosa Chacón-Diaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | | | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
| | - Bernardo A Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Abstract
Anemia affects millions of patients with chronic kidney disease (CKD) and prompt iron supplementation can lead to reductions in the required dose of erythropoiesis-stimulating agents, thereby reducing medical costs. Oral and intravenous (IV) traditional iron preparations are considered far from ideal, primarily due to gastrointestinal intolerability and the potential risk of infusion reactions, respectively. Fortunately, the emergence of novel iron replacement therapies has engendered a paradigm shift in the treatment of iron deficiency anemia in patients with CKD. For example, oral ferric citrate is an efficacious and safe phosphate binder that increases iron stores to maintain hemoglobin levels. Additional benefits include reductions in fibroblast growth factor 23 levels and the activation of 1,25 dihydroxyvitamin D. The new-generation IV iron preparations ferumoxytol, iron isomaltoside 1000, and ferric carboxymaltose are characterized by a reduced risk of infusion reactions and are clinically well tolerated as a rapid high-dose infusion. In patients undergoing hemodialysis (HD), ferric pyrophosphate citrate (FPC) administered through dialysate enables the replacement of ongoing uremic and HD-related iron loss. FPC transports iron directly to transferrin, bypassing the reticuloendothelial system and avoiding iron sequestration. Moreover, this paper summarizes recent advancements of hypoxia-inducible factor prolyl hydroxylase inhibitors and future perspectives in renal anemia management.
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Affiliation(s)
- Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (K.-H.L.); (Y.H.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11217, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDSB), Hsinchu 300, Taiwan
| | - Yang Ho
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (K.-H.L.); (Y.H.)
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (K.-H.L.); (Y.H.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11217, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDSB), Hsinchu 300, Taiwan
- Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu 300, Taiwan
- Department and Institute of Physiology, National Yang-Ming University, Taipei 11217, Taiwan
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27
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de Castro C, Grossi F, Weitz IC, Maciejewski J, Sharma V, Roman E, Brodsky RA, Tan L, Di Casoli C, El Mehdi D, Deschatelets P, Francois C. C3 inhibition with pegcetacoplan in subjects with paroxysmal nocturnal hemoglobinuria treated with eculizumab. Am J Hematol 2020; 95:1334-1343. [PMID: 33464651 PMCID: PMC7693064 DOI: 10.1002/ajh.25960] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/21/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, life-threatening hematologic disease characterized by chronic complement-mediated hemolysis and thrombosis. Despite treatment with eculizumab, a C5 inhibitor, 72% of individuals remain anemic. Pegcetacoplan (APL-2), a PEGylated C3 inhibitor, has the potential to provide more complete hemolysis control in patients with PNH. This open-label, phase Ib study was designed to assess the safety, tolerability, and pharmacokinetics of pegcetacoplan in subjects with PNH who remained anemic during treatment with eculizumab. Pharmacodynamic endpoints were also assessed as an exploratory objective of this study. Data are presented for six subjects in cohort 4 who received treatment for up to 2 years. In total, 427 treatment-emergent adverse events (TEAEs) were reported, 68 of which were possibly related to the study drug. Eight serious TEAEs occurred in two subjects; three of these events were considered possibly related to the study drug. Pegcetacoplan pharmacokinetic concentrations accumulated with repeated dosing, and steady state was reached at approximately 6-8 weeks. Lactate dehydrogenase levels were well controlled by eculizumab at baseline. Pegcetacoplan increased hemoglobin levels and decreased both reticulocyte count and total bilirubin in all six subjects. Improvements were observed in Functional Assessment of Chronic Illness Therapy Fatigue scores. Two subjects discontinued for reasons unrelated to pegcetacoplan. All four subjects who completed the study transitioned to pegcetacoplan monotherapy following eculizumab discontinuation and avoided transfusions. In this small study, pegcetacoplan therapy was generally well-tolerated, and resulted in an improved hematological response by achieving broad hemolysis control, enabling eculizumab discontinuation.
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MESH Headings
- Adult
- Anemia, Hemolytic/drug therapy
- Anemia, Hemolytic/etiology
- Anemia, Hemolytic/prevention & control
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Bilirubin/blood
- Chemical and Drug Induced Liver Injury/etiology
- Complement C3/antagonists & inhibitors
- Complement C5/antagonists & inhibitors
- Drug Substitution
- Female
- Fever/chemically induced
- Hemoglobins/analysis
- Hemoglobinuria, Paroxysmal/blood
- Hemoglobinuria, Paroxysmal/drug therapy
- Hemoglobinuria, Paroxysmal/immunology
- Hemolysis/drug effects
- Humans
- L-Lactate Dehydrogenase/blood
- Male
- Middle Aged
- Pancreatitis/chemically induced
- Prospective Studies
- Reticulocyte Count
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Affiliation(s)
| | | | | | - Jaroslaw Maciejewski
- Translational Hematology and Oncology ResearchTaussig Cancer InstituteClevelandOhioUSA
| | | | | | | | - Lisa Tan
- Lisa Tan Pharma Consulting LtdCambridgeUK
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28
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Amedimele KD, Marcaggi X, Ferrier N, Berteau E, Damey PM, Aswad K, Bitar G, Tixier V, Clerfond G. [Mitral stenosis and acute hemolytic anemia after mitraclip]. Ann Cardiol Angeiol (Paris) 2020; 69:327-331. [PMID: 32981658 DOI: 10.1016/j.ancard.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
Mitraclip corrects mitral regurgitation in a less invasive way than cardiac surgery. These procedures are becoming widespread with the emergence of new complications. We report a rare case of mitral stenosis associated with acute hemolytic anemia after mitraclip treatment in an 82-year-old patient. The cause of this stenosis in our case is linked to the placement of two clips and an increase gradient in post-procedure. The mechanism of hemolysis could be due to the persistence of mitral leaks resulting in strong collisions against the clip.
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Affiliation(s)
- K D Amedimele
- Service de cardiologie, centre hospitalier Jacques-Lacarin, 03200 Vichy, France; Service de cardiologie, centre hospitalier universitaire Mohammed VI de Marrakech, BP 2360, Marrakech, Maroc.
| | - X Marcaggi
- Service de cardiologie, centre hospitalier Jacques-Lacarin, 03200 Vichy, France
| | - N Ferrier
- Service de cardiologie, centre hospitalier Jacques-Lacarin, 03200 Vichy, France
| | - E Berteau
- Service de cardiologie, centre hospitalier Jacques-Lacarin, 03200 Vichy, France
| | - P M Damey
- Service de cardiologie, centre hospitalier universitaire Ignace Deen, Conakry, Guinée
| | - K Aswad
- Service de cardiologie, centre hospitalier Jacques-Lacarin, 03200 Vichy, France
| | - G Bitar
- Service de cardiologie, centre hospitalier Jacques-Lacarin, 03200 Vichy, France
| | - V Tixier
- Service de cardiologie, centre hospitalier Jacques-Lacarin, 03200 Vichy, France
| | - G Clerfond
- Service de cardiologie, centre hospitalier universitaire Gabriel-MontPied, 63000 Clermont Ferrand, France
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Caré W, Mérat B, Foissaud V. [Severe hemolysis in a patient with prosthetic heart valve]. Rev Prat 2020; 70:184. [PMID: 32877137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Weniko Caré
- Service de médecine interne, hôpital d'instruction des armées Percy, Clamart, France
| | - Benoît Mérat
- Service de cardiologie et médecine aéronautique, hôpital d'instruction des armées Percy, Clamart, France
| | - Vincent Foissaud
- Laboratoire de biologie médicale, hôpital d'instruction des armées Percy, Clamart, France
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Khan KA, Qureshi SU, Khalid L, Wahid K. A typical presentation of dengue fever in a G6PD deficient patient: A case report. J PAK MED ASSOC 2019; 69:1553-1556. [PMID: 31622316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dengue is a mosquito-borne viral disease that has rapidly spread in the recent years, particularly in South Asia. While haematologic complications, such as cytopenia and bleeding, may occur in severe dengue infection, reports of haemolytic anaemia in dengue fever are scant. We report a patient who developed haemolytic anaemia following dengue fever. A 45 years old gentleman presented with five-day history of fever and was recently diagnosed with dengue fever. He developed jaundice and started vomiting on the third day of his clinical course. His laboratory investigations revealed deranged liver profile, Coombs negative haemolytic anaemia and G6PD deficiency. He was treated conservatively with fluids and blood transfusions. His liver functions and haemolytic anaemia gradually resolved. This case highlights the importance of recognising dengue fever-induced haemolytic anaemia in a G6PD deficient patient by physicians and pathologists, enabling better diagnosis and improved management of this life-threatening condition.
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Affiliation(s)
| | | | - Luma Khalid
- Northwest General Hospital, Peshawar, Pakistan
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31
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Abstract
Red blood cell (RBC) transfusion therapy is a key component in the comprehensive management of patients with sickle cell disease (SCD). Consequently, most adult SCD patients will receive at least one, and many will receive more than a hundred RBC transfusions in their lifetime. SCD patients develop RBC alloantibodies much more frequently than non-SCD transfused patients, which often make the selection of compatible RBCs extremely difficult, in addition to placing patients at significantly higher risk of suffering from delayed hemolytic transfusion reactions (DHTRs). Similar to alloimunization, DHTRs are much more common in patients with SCD compared to other heavily transfused populations, and are particularly consequential due to their propensity to cause hyperhemolysis, a life-threatening phenomenon in which both transfused RBCs in addition to the patient's own sickle-erythrocytes are destroyed. In this review, we highlight the incidence and pathophysiology of DHTRs; illustrate common presentations, appropriate evaluations and outcomes of DHTRs in patients with SCD; and discuss strategies for preventing or reducing the likelihood of DHTRs from occurring.
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Affiliation(s)
- R M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA.
| | - M J Miller
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
| | - S Chonat
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics and Hematology/Oncology, Emory University School of Medicine, Atlanta GA, USA
| | - S R Stowell
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
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32
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Abstract
Objective: To explore the clinical features and points of diagnosis and treatment for congenital thrombotic thrombocytopenic purpura (TTP) in children. Methods: The clinical manifestations, laboratory tests, genetic analysis and treatments of 5 children with congenital TTP hospitalized in Beijing Children's Hospital, Capital Medical University from February 2015 to July 2017 were analyzed retrospectively. Results: Among the 5 children with congenital TTP diagnosed by genetic monitoring and enzymology, there were 1 male and 4 females, 3 cases had suspicious positive family history, the age of onset was several hours after birth (range several hours after birth to 28 months). The main clinical manifestations were recurrent moderate to severe thrombocytopenia in 5 cases, mild to moderate hemolytic anemia in 4 cases, proteinuria or hematuria in 2 cases, and nervous system involvement in 1 case. The recurrence time was 1.5 (range 1.0 to 5.0) times per year and most of the inducing factors were respiratory and (or) digestive tract infections. Laboratory test showed that ADMATS13 enzyme activity were 0 in 4 cases, the enzyme activity was 100% in 1 case due to plasma infusion before examination. ADMATS13 enzyme antibody detection of all 5 cases were negative. Genetic analysis of all 5 children showed complex heterozygous mutations at different loci of ADAMTS13 gene, among which 8 loci were previously unreported, details are as follows: missense mutations in 4 cases (c.1564T>C(p.522C>R), c.1510G>T(p.504D>Y), c.4154A>C(p.1385Q>P) and c.G3854C (P.R1285P)); frameshift mutations in 3 cases(c.2875_2876insT (p.959Lfs29), c.2362_2363delGG (p.788G>Gfs56) and c.1335delC (p.F445fs)), shear mutation in one case(IVS21+1A>G). The patients in the acute phase were all treated with fresh frozen plasma infusion (10 ml/(kg·d)), continuous application for 7-14 days). Platelets gradually returned to normal and clinical symptoms improved. The follow-up time was 27 months (range 11-35 months). All the children survived, among whom 2 cases were treated with prophylaxis and monitoring platelet stability above 200×10(9)/L, 3 cases were treated on-demand only when platelet decreased and monitoring platelet stability above 100×10(9)/L. Conclusions: The main clinical manifestation of congenital TTP is recurrent thrombocytopenia with or without hemolytic anemia. The key point of treatment is plasma infusion. Genetic testing is helpful for early diagnosis.
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Affiliation(s)
- L L Fu
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Murakami A, Kamei Y, Kusakabe E, Yamasawa H, Aoki R, Komatsu S, Taguchi K, Nishiyama K, Yamashita M, Sugimori W, Asai H, Mizuno Y, Takada Y. [A Case of Microangiopathic Hemolytic Anemia with Bone Marrow Carcinomatosis from Breast Cancer]. Gan To Kagaku Ryoho 2018; 45:1105-1107. [PMID: 30042282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report a case of microangiopathic hemolytic anemia(MHA)caused by metastatic breast cancer treated with weekly paclitaxel. A 58-year-old woman was diagnosed with metastatic breast cancer 2 years earlier. She was treated with various chemotherapy regimens and hormonal therapy, before being switched to fulvestrant 3 months earlier. She presented with severe anemia, and was diagnosed with MHA with bone marrow carcinomatosis following bone marrow biopsy. She was treated with weekly paclitaxel and recovered successfully. A subsequent biopsy showed that the bone marrow carcinomatosis had decreased. MHA due to breast cancer is rare and is associated with poor prognosis; however, rapid initiation of chemotherapy may be effective.
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35
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Pogliani EM, Fowst C, Maffé P, Marozzi A, Stefani M, Polli E. CNS Metastasis in Ovarian Cancer with Microangiopathic Hemolytic Anemia Associated with Diffuse Intravascular Coagulation. Tumori 2018; 74:731-6. [PMID: 3232217 DOI: 10.1177/030089168807400619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the case of a woman affected by ovarian cancer metastatic to multiple lymph node and the CNS. She was affected by hemorrhagic diathesis with microangiopathic alterations, whereas coagulopathy developed only after some days in coincidence with disease worsening. Our patient is probably one of those in which cancer leads to microangiopathy and coagulopathy by means of a tissue factor-like activity, a common event in mucin secretory tumors. Fibrinolytic activity was also increased in our patient as in others of the same type. The main aspect of this case report is metastasis to the CNS and to other multiple sites, which is quite uncommon in such cancers. We retain that tumor procoagulant activity could have played a role in this phenomenon.
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Affiliation(s)
- E M Pogliani
- Istituto di Scienze Mediche dell'Università di Milano, Italia
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36
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Ågren A, Antovic J, Strandberg K, Frisk T, Löfstedt P, Strindfors G, Celsing F. [Not Available]. Lakartidningen 2018; 115:EYWT. [PMID: 29558005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Anna Ågren
- Institutionen för medicin, Karolinska Institutet - Koagulationsmottagningen, Hematologiskt Centrum, Karolinska Universitetssjukhuset Stockholm, Sweden - , Sweden
| | - Jovan Antovic
- Karolinska universitetslaboratoriet Klinisk kemi avdelningen - Stockholm, Sweden Karolinska universitetslaboratoriet Klinisk kemi avdelningen - Stockholm, Sweden
| | - Karin Strandberg
- Klinisk kemi - Laboratoriemedicin i Skåne Malmö, Sweden Klinisk kemi - Laboratoriemedicin i Skåne Malmö, Sweden
| | - Tony Frisk
- Barnkliniken - Astrid Lindgrens barnsjukhus Stockholm, Sweden Barnkliniken - Astrid Lindgrens barnsjukhus Stockholm, Sweden
| | - Pia Löfstedt
- Anestesikliniken, Södersjukhuset - Stockholm, Sweden Anestesikliniken, Södersjukhuset - Stockholm, Sweden
| | - Gita Strindfors
- Kvinnokliniken, Södersjukhuset - Stockholm, Sweden Kvinnokliniken, Södersjukhuset - Stockholm, Sweden
| | - Fredrik Celsing
- Hematologiskt Centrum, Karolinska Universitetssjukhuset - Stockholm, Sweden Hematologiskt Centrum, Karolinska Universitetssjukhuset - Stockholm, Sweden
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37
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Abstract
Bone marrow steady-state erythropoiesis maintains erythroid homeostasis throughout life. This process constantly generates new erythrocytes to replace the senescent erythrocytes that are removed by macrophages in the spleen. In contrast, anemic or hypoxic stress induces a physiological response designed to increase oxygen delivery to the tissues. Stress erythropoiesis is a key component of this response. It is best understood in mice where it is extramedullary occurring in the adult spleen and liver and in the fetal liver during development. Stress erythropoiesis utilizes progenitor cells and signals that are distinct from bone marrow steady-state erythropoiesis. Because of that observation many genes may play a role in stress erythropoiesis despite having no effect on steady-state erythropoiesis. In this chapter, we will discuss in vivo and in vitro techniques to study stress erythropoiesis in mice and how the in vitro culture system can be extended to study human stress erythropoiesis.
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Affiliation(s)
- Laura F Bennett
- Department of Veterinary and Biomedical Sciences and Center for Molecular Immunology and Infectious Disease. Laura Bennett and Robert Paulson are Intercollege Graduate Program in Genetics. Robert Paulson and Chang Liao are Pathobiology Graduate Program, The Pennsylvania State University, 115 Henning Building, University Park, PA, 16802, USA
| | - Chang Liao
- Department of Veterinary and Biomedical Sciences and Center for Molecular Immunology and Infectious Disease. Laura Bennett and Robert Paulson are Intercollege Graduate Program in Genetics. Robert Paulson and Chang Liao are Pathobiology Graduate Program, The Pennsylvania State University, 115 Henning Building, University Park, PA, 16802, USA
| | - Robert F Paulson
- Department of Veterinary and Biomedical Sciences and Center for Molecular Immunology and Infectious Disease. Laura Bennett and Robert Paulson are Intercollege Graduate Program in Genetics. Robert Paulson and Chang Liao are Pathobiology Graduate Program, The Pennsylvania State University, 115 Henning Building, University Park, PA, 16802, USA.
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38
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Taşkıran EZ, Sönmez HE, Ayvaz DÇ, Koşukcu C, Batu ED, Esenboğa S, Topaloğlu R, Orhan D, Bilginer Y, Alikaşifoğlu M, Özen S, Tezcan İ. Hypomorphic RAG1 defect in a child presented with pulmonary hemorrhage and digital necrosis. Clin Immunol 2017; 187:92-94. [PMID: 29107076 DOI: 10.1016/j.clim.2017.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Ekim Z Taşkıran
- Department of Medical Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Hafize E Sönmez
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Ç Ayvaz
- Department of Pediatrics, Division of Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Can Koşukcu
- Department of Bioinformatics, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ezgi D Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Saliha Esenboğa
- Department of Pediatrics, Division of Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rezan Topaloğlu
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatrics, Division of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Alikaşifoğlu
- Department of Medical Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlhan Tezcan
- Department of Pediatrics, Division of Immunology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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39
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Iioka F, Toda Y, Nagai Y, Akasaka T, Shimomura D, Tsuda K, Nakamura F, Ohno H. Delayed Development of Hemolytic Anemia with Fragmented Red Blood Cells and Cardiac and Renal Impairments after High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation for Malignant Lymphoma. Acta Haematol 2017; 138:152-161. [PMID: 28972944 DOI: 10.1159/000480288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/10/2017] [Indexed: 11/19/2022]
Abstract
Among 42 consecutive patients with malignant lymphoma who underwent high-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (AHSCT), 5 developed hemolytic anemia with fragmented red blood cells (HA-FrRBCs) on days 87-125 (median 107) of AHSCT. Nadir Hb levels ranged between 5.0 and 6.4 g/dL with 2.2-5.6% FrRBCs. All patients developed grade ≥3 hypoxia and heart failure, and 4 developed grade ≥3 hypertension. The ejection fraction of the left ventricle assessed by echocardiography was significantly reduced in 3 patients. Peak creatinine levels were >4 times above the baseline and estimated glomerular filtration rates were reduced to <30 mL/min/1.73 m2. One patient received plasma exchange, while the remaining 4 responded to treatment with diuretics and cardiovascular agents. Hematological parameters normalized within a median duration of 91 days after the development of HA-FrRBCs. Renal and cardiac functions gradually improved, even though renal function did not return to the baseline. HA-FrRBCs associated with cardiac and renal impairments may represent a thrombotic microangiopathy syndrome and are a delayed complication of HDC/AHSCT. The close monitoring of laboratory abnormalities and persistent treatment with cardiovascular agents and diuretics are the mainstay for the management of this condition.
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Affiliation(s)
- Futoshi Iioka
- Department of Hematology, Tenri Hospital, Tenri, Japan
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40
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Mehta P, Srivastav V, Bhate P, Gupta V, Nadkar MY. Glucose-6-Phosphate Dehydrogenase Deficiency Unveiled by Diabetic Ketoacidosis: A Dual Dilemma. J Assoc Physicians India 2017; 65:98-102. [PMID: 28799315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An 18 year old male, known case of Type 1 Diabetes Mellitus was admitted in view of diabetic ketoacidosis. With normalization of blood sugars patient developed gross reddish discoloration of urine. Urine routine microscopy did not reveal RBCs or RBC casts. Peripheral blood smear revealed bite cells, Heinz bodies and spherocytes. Thus a diagnosis of hemolytic anemia with hemoglobinuria was made. Patient's glucose-6-phosphate dehydrogenase (G6PD) levels were below the normal range. G6PD, an enzyme of the HMP shunt, is the most common enzyme defect causing hemolytic anemia. G6PD deficiency related hemolytic crisis is most commonly precipitated by infection, drugs or fava beans. Its association with DKA has been seldom reported.
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Affiliation(s)
| | | | | | | | - Milind Y Nadkar
- Professor, Dept. of Medicine and Intensive Care, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
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41
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Takamaru R, Kawahito K, Aizawa K, Misawa Y. [Intravascular Hemolysis Caused by Stenosis of an Elephant Trunk;Report of a Case]. Kyobu Geka 2017; 70:514-517. [PMID: 28698420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Symptomatic intravascular hemolysis after prosthetic aortic graft replacement is rare. It is primarily attributed to mechanical injury of red blood cells caused by stenosis of the vascular graft. A 50-year-old man presented with hemolytic anemia, 5 years after total arch replacement with an elephant trunk for type A aortic dissection. The hemolysis was caused by graft stenosis of the elephant trunk. Endovascular treatment for the stenotic elephant trunk was successfully performed. The postoperative course was uneventful, and the hemolysis was resolved immediately after operation.
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Affiliation(s)
- Rikako Takamaru
- Department of Cardiothoracic Surgery, Jichi Medical University, Tochigi, Japan
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42
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Shahid M. Microangiopathic haemolytic anaemia (maha) caused by non O157:H7 E-coli. J PAK MED ASSOC 2017; 67:962-963. [PMID: 28585607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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43
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Nishimoto T, Bonkohara Y, Iijima M. [Delayed Hemolytic Anemia Associated with Anti-Jk3 Antibody Following Cardiovascular Surgery;Report of a Case]. Kyobu Geka 2017; 70:457-460. [PMID: 28595228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a 73-year-old man who underwent total aortic arch replacement with an open stent graft for aortic arch aneurysm. The patient received blood transfusion intraoperatively without any signs of hemolysis. However, on post-operative day 16, he developed hemoglobinuria, and was found to have anemia, elevated serum lactate dehydrogenase, elevated total bilirubin, and decreased serum haptoglobin. Initially, the cause for these findings was unknown. Upon further testing, however, antibodies against the high frequency antigen, anti-Jk3 was identified. The patient was conservatively treated and was discharged in stable condition on post-operative day 24. Jka and/or Jkb are red blood cell antigens observed in over 99.9% of the population worldwide. Jk (a-b-) represents the null phenotype and is very rare. This specific phenotype can be extremely dangerous, as homologous transfusion might cause severe delayed hemolysis. The actual patient carried Jk (a-b-) phenotype and, due to intraoperative transfusion of red blood cells, anti-Jk3 antibody was produced. Although very rare, patients who carry the red blood cell phenotype Jk( a-b-) may experience dangerous, or even fatal outcome due to such a common medical treatment as blood transfusion, if this condition is not recognized beforehand.
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Affiliation(s)
- Takayuki Nishimoto
- Department of Cardiovascular Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
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Gunawardena S, Kapilananda GMG, Samarakoon D, Maddevithana S, Wijesundera S, Goonaratne LV, Karunaweera ND. Prevalence of G6PD deficiency in selected populations from two previously high malaria endemic areas of Sri Lanka. PLoS One 2017; 12:e0171208. [PMID: 28152025 PMCID: PMC5289554 DOI: 10.1371/journal.pone.0171208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/18/2017] [Indexed: 02/07/2023] Open
Abstract
Glucose-6-Phosphate Dehydrogenase (G6PD) enzyme deficiency is known to offer protection against malaria and an increased selection of mutant genes in malaria endemic regions is expected. However, anti-malarial drugs such as primaquine can cause haemolytic anaemia in persons with G6PD deficiency. We studied the extent of G6PD deficiency in selected persons attending Teaching Hospitals of Anuradhapura and Kurunegala, two previously high malaria endemic districts in Sri Lanka. A total of 2059 filter-paper blood spots collected between November 2013 and June 2014 were analysed for phenotypic G6PD deficiency using the modified WST-8/1-methoxy PMS method. Each assay was conducted with a set of controls and the colour development assessed visually as well as with a microplate reader at OD450-630nm. Overall, 142/1018 (13.95%) and 83/1041 (7.97%) were G6PD deficient in Anuradhapura and Kurunegala districts respectively. The G6PD prevalence was significantly greater in Anuradhapura when compared to Kurunegala (P<0.0001). Surprisingly, females were equally affected as males in each district: 35/313 (11.18%) males and 107/705 (15.18%) females were affected in Anuradhapura (P = 0.089); 25/313 (7.99%) males and 58/728 (7.97%) females were affected in Kurunegala (P = 0.991). Prevalence was greater among females in Anuradhapura than in Kurunegala (P<0.05), while no such difference was observed between the males (P>0.05). Severe deficiency (<10% normal) was seen among 28/1018 (2.75%) in Anuradhapura (7 males; 21 females) and 17/1041 (1.63%) in Kurunegala (7 males; 10 females). Enzyme activity between 10–30% was observed among 114/1018 (11.20%; 28 males; 86 females) in Anuradhapura while it was 66/1041 (6.34%; 18 males; 48 females) in Kurunegala. Screening and educational programmes for G6PD deficiency are warranted in these high risk areas irrespective of gender for the prevention of disease states related to this condition.
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Affiliation(s)
- Sharmini Gunawardena
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- * E-mail:
| | - G. M. G. Kapilananda
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Dilhani Samarakoon
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sashika Maddevithana
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Sulochana Wijesundera
- Department of Biochemistry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Nadira D. Karunaweera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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45
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Loomis Z, Eigenberger P, Redinius K, Lisk C, Karoor V, Nozik-Grayck E, Ferguson SK, Hassell K, Nuss R, Stenmark K, Buehler P, Irwin DC. Hemoglobin induced cell trauma indirectly influences endothelial TLR9 activity resulting in pulmonary vascular smooth muscle cell activation. PLoS One 2017; 12:e0171219. [PMID: 28152051 PMCID: PMC5289566 DOI: 10.1371/journal.pone.0171219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022] Open
Abstract
It is now well established that both inherited and acquired forms of hemolytic disease can promote pulmonary vascular disease consequent of free hemoglobin (Hb) induced NO scavenging, elevations in reactive oxygen species and lipid peroxidation. It has recently been reported that oxidative stress can activate NFkB through a toll-like receptor 9 (TLR9) mediated pathway; further, TLR9 can be activated by either nuclear or mitochondrial DNA liberated by stress induced cellular trauma. We hypothesis that Hb induced lipid peroxidation and subsequent endothelial cell trauma is linked to TLR9 activation, resulting in IL-6 mediated pulmonary smooth muscle cell proliferation. We examined the effects of Hb on rat pulmonary artery endothelial and smooth muscle cells (rPAEC and rPASMC, respectively), and then utilized TLR9 and IL6 inhibitors, as well as the Hb and heme binding proteins (haptoglobin (Hp) and hemopexin (Hpx), respectively) to further elucidate the aforementioned mediators. Further, we explored the effects of Hb in vivo utilizing endothelial cell (EC) specific myeloid differentiation primary response gene-88 (MyD88) and TLR9 null mice. Our data show that oxidized Hb induces lipid peroxidation, cellular toxicity (5.5 ± 1.7 fold; p≤0.04), increased TLR9 activation (60%; p = 0.01), and up regulated IL6 expression (1.75±0.3 fold; p = 0.04) in rPAEC. Rat PASMC exhibited a more proliferative state (13 ± 1%; p = 0.01) when co-cultured with Hb activated rPAEC. These effects were attenuated with the sequestration of Hb or heme by Hp and Hpx as well as with TLR9 an IL-6 inhibition. Moreover, in both EC-MyD88 and TLR9 null mice Hb-infusion resulted in less lung IL-6 expression compared to WT cohorts. These results demonstrate that Hb-induced lipid peroxidation can initiate a modest TLR9 mediated inflammatory response, subsequently generating an activated SMC phenotype.
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Affiliation(s)
- Zoe Loomis
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Paul Eigenberger
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Katherine Redinius
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Christina Lisk
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Vijaya Karoor
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Eva Nozik-Grayck
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Scott K. Ferguson
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Kathryn Hassell
- Division of Hematology and Colorado Sickle Cell Treatment and Research Center, University of Colorado-Denver School of Medicine, Aurora, Colorado, United States of America
| | - Rachelle Nuss
- Division of Hematology and Colorado Sickle Cell Treatment and Research Center, University of Colorado-Denver School of Medicine, Aurora, Colorado, United States of America
| | - Kurt Stenmark
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Paul Buehler
- Division of Hematology, The Center for Biologics Evaluation and Research, United States Food and Drug Administration, Bethesda, Maryland, United States of America
| | - David C. Irwin
- Cardiovascular and Pulmonary Research Laboratory, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
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Jimmerson LC, Clayton CW, MaWhinney S, Meissner EG, Sims Z, Kottilil S, Kiser JJ. Effects of ribavirin/sofosbuvir treatment and ITPA phenotype on endogenous purines. Antiviral Res 2017; 138:79-85. [PMID: 27956135 PMCID: PMC10837792 DOI: 10.1016/j.antiviral.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/23/2016] [Accepted: 12/03/2016] [Indexed: 12/15/2022]
Abstract
Ribavirin (RBV), a purine analog, causes hemolytic anemia in some patients. In vitro, anemia appears to result from depletion of endogenous purines, but there are limited data in vivo. Single nucleotide polymorphisms in the gene encoding the inosine triphosphatase (ITPA) enzyme have been associated with protection against RBV-induced anemia and may mediate the effect of RBV treatment on endogenous purines. The purpose of this work was to determine the effect of RBV treatment on endogenous purine concentrations in individuals being treated for chronic hepatitis C virus (HCV) infection. Adenosine triphosphate (ATP), guanosine triphosphate (GTP), inosine triphosphate (ITP) and ribavirin triphosphate (RTP) were measured in whole blood obtained from 47 HCV-infected individuals at day zero (baseline), day three, day 28 and day 84 of RBV/sofosbuvir (SOF) treatment. ATP decreased -35.1% and -38.6% (p < 0.0001) at day 28 and day 84 of treatment, respectively compared to baseline. The decrease in ATP was greater in patients with ≤60% ITPA activity compared to those with 100% ITPA activity (-29.4% vs. -9.6%). GTP did not change during treatment but was 16.5% (p = 0.01) higher per 100 pmol/106 cells RTP in those with 100% ITPA activity. No significant change or effect of RTP or ITPA phenotype was noted for ITP. In summary, only ATP was reduced by RBV/SOF treatment and ITPA variants had larger reductions in ATP suggesting RBV-induced anemia is due to a different mechanism than predicted from in-vitro studies. These data emphasize the importance of characterizing the effect of nucleos(t)ide analog treatment on endogenous purines in-vivo.
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Affiliation(s)
- Leah C Jimmerson
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora, CO, USA
| | | | | | - Eric G Meissner
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Zayani Sims
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Shyamasundaran Kottilil
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer J Kiser
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora, CO, USA.
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47
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Esposito I, Benítez-Gutiérrez L, Treviño A, Arias A, Citores MJ, Requena S, Soriano V, Cuervas-Mons V, de Mendoza C. Impact of ITPA gene polymorphisms on the risk of ribavirin-induced haemolytic anaemia using interferon-free antivirals for chronic hepatitis C. Antivir Ther 2017; 22:571-575. [PMID: 28198349 DOI: 10.3851/imp3138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) at the ITPA gene are associated with haemolytic anaemia in chronic hepatitis C patients treated with pegylated interferon-ribavirin (RBV). Information in patients treated with interferon-free, direct-acting antivirals (DAA) is scarce. METHODS Median haemoglobin (Hb) levels were compared at baseline and at week 4, when ribavirin concentration achieves steady state, in all consecutive chronic hepatitis C patients treated with oral DAA plus RBV at our clinic. RESULTS Median Hb drop in 55 patients was greater in rs1127354-CC than -CA/AA (1.8 versus 0.7 g/dl; P=0.029), and in rs6051702-AA than -AC/CC carriers (2.2 versus 1.1 g/dl; P=0.016). Eleven (20%) patients experienced severe anaemia, defined as Hb drop >3 g/dl or to <10 g/dl. All of them were rs6051702-AA. CONCLUSIONS Baseline testing of rs6051702 may identify the subset of patients at greatest risk for RBV-induced anaemia using interferon-free hepatitis C therapies.
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Affiliation(s)
- Isabella Esposito
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
- Infectious Diseases Unit, La Paz University Hospital & IdiPAZ, Madrid, Spain
| | - Laura Benítez-Gutiérrez
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
| | - Ana Treviño
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
| | - Ana Arias
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
| | - Maria Jesus Citores
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
| | - Silvia Requena
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
| | - Vicente Soriano
- Infectious Diseases Unit, La Paz University Hospital & IdiPAZ, Madrid, Spain
| | - Valentín Cuervas-Mons
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
| | - Carmen de Mendoza
- Department of Internal Medicine & Liver Transplantation Unit, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Spain
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Abstract
Advanced cancer and life-limiting chronic nonmalignant diseases are associated with a number of hematological problems. Anemia and coagulation disorders, principally venous thrombosis and thrombocytopenia, are most commonly observed. Patients undergoing chemotherapy and bone marrow transplant have unique problems that include neutropenias and chemotherapy-induced drug toxicities, which will not be covered in this article.
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Affiliation(s)
- Mellar P Davis
- The Harrny R. Horvitz Center for Palliative Medicine, Cleveland Taussig Cancer Center, Cleveland, Ohio, USA
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Abstract
Mycophenolate mofetil (MMF) has been increasingly used in patients with systemic lupus erythematosus (SLE). While most information concentrates on lupus nephritis, its efficacy in nonrenal manifestations of SLE has not been systematically studied. We describe the successful use of MMF in a patient with SLE-related hemolytic anemia that was refractory to cyclophosphamide, pulse methylprednisolone, intravenous immunoglobulin and cyclosporine. The mechanisms of action of MMF are briefly reviewed.
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MESH Headings
- Adult
- Anemia, Hemolytic/drug therapy
- Anemia, Hemolytic/etiology
- Anemia, Hemolytic/pathology
- Anemia, Refractory/drug therapy
- Anemia, Refractory/etiology
- Anemia, Refractory/pathology
- Dose-Response Relationship, Drug
- Female
- Glucocorticoids/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/pathology
- Mycophenolic Acid/analogs & derivatives
- Mycophenolic Acid/therapeutic use
- Treatment Outcome
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Affiliation(s)
- A Mak
- Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong SAR, China.
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50
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Almeida-Morais L, Fiarresga A, Cacela D, de Sousa L, Galrinho A, Rodrigues R, Ferreira L, Ferreira R. New-Onset Hemolytic Anemia after Percutaneous Paravalvular Leak Closure. J Heart Valve Dis 2016; 25:494-497. [PMID: 28009956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Despite being usually clinically silent, paravalvular leak can present with congestive heart failure (CHF) or haemolytic anemia. Here, the case is reported of a paravalvular leak presenting with CHF, complicated by new-onset severe hemolytic anemia after percutaneous closure with a large ventricular septal duct (VSD) occlude device. METHODS A 57-year-old patient presented with infectious endocarditis of a native mitral valve with major mitral regurgitation and was submitted for mitral valvuloplasty. However, one month later failure of the valvuloplasty forced the need for mechanical prosthetic valve implantation. Early endocarditis of the mechanical valve with CHF was noted two months later and led to mechanical valve substitution. One year later the patient presented with a major paravalvular leak and CHF recurrence. Hence, percutaneous paravalvular leak closure was proposed. RESULTS A 16-mm VSD occluder was used, and clinical and echocardiography success was noticed. However, new-onset hemolytic anemia with acute kidney injury forced surgical re-intervention, with the successful implantation of a third mechanical valve. CONCLUSIONS Usually, percutaneous paravalvular leak closure is a safe and successful method to treat high-risk surgical patients. However, hemolytic anemia may develop after a technically successful procedure, forcing surgical intervention. Dedicated devices are needed to overcome this important safety issue. Video 1: Periprocedural acquisition of 3-D transesophageal echocardiography showing two AVP II in the left atrium after unsuccessful deployment. Video 2: Periprocedural imaging of a muscular ventricular septal duct (mVSD) occluder (16 mm), with successful closure of the paravalvular leak.
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Affiliation(s)
- Luís Almeida-Morais
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal. Electronic correspondence:
| | - António Fiarresga
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
| | - Duarte Cacela
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
| | - Lídia de Sousa
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
| | - Ana Galrinho
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
| | - Rui Rodrigues
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
| | - Lurdes Ferreira
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
| | - Rui Ferreira
- Cardiology Department, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisbon, Portugal
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