Curso clínico da anemia hemolítica auto-imune: um estudo descritivo

Abstract

Objective: Autoimmune hemolytic anemia is characterized by the production of autoantibodies against erythrocyte membrane antigens. This study was carried out to identify the clinical, immunological and outcome characteristics of autoimmune hemolytic anemia patients treated at the (HC-UFMG) Pediatric Hematology Unit and the Hemocentro de Belo Horizonte. Methods:We evaluated 17 patients younger than 15 years old admitted from 1988 to 2003 were evaluated. Autoimmune hemolytic anemia diagnosis was based on the presence of acquired hemolysis and confirmed by positive direct Coombs polyspecific test results. Clinical, laboratory, and outcome data were obtained from patient records. Results:The median age at diagnosis was 10.5 months. The direct Coombs polyspecific test was positive in 13 and negative in four patients. Monospecific testing was performed for 14 patients. The most frequent red cell autoantibody was IgG (five patients), followed by IgM in two. Thirteen patients had severe anemia and needed blood transfusions. Underlying diseases were identified in four patients: systemic lupus erythematosus, Hodgkins lymphoma, autoimmune hepatitis and Langerhans cell histiocytosis. The remaining patients were classified as having primary disease. The median follow-up period was 11 months (5 to 23 months). Three children died, two after splenectomy and one with complications of the underlying disease. Conclusion:Autoimmune hemolytic anemia is rare in children and adolescents. Although patients usually respond to corticosteroids and/or immunoglobulin, fatal cases can occur. Prognosis is worse in patients with chronic underlying diseases.

Partial and simultaneous remission of nephritis and autoimmune hemolytic anemia in patients with lupus after treatment with biological agent: a case report

“…Caracteriza-se pela hemólise exacerbada devido à fixação de imunoglobulinas na superfície da membrana eritrocitária, reticulocitose, queda dos níveis de haptoglobina, aumento da concentração de bilirrubina indireta e teste de Coombs direto positivo. 5,6,7 O tratamento da NL consiste em duas fases: na de indução da remissão, com pulso de metilprednisolona e ciclofosfamida ou pulso de metilprednisolona e micofenolato de mofetila; e na fase de manutenção da remissão, com prednisona e azatioprina ou micofenolato de mofetila, este último com menos efeitos adversos. 1,2 A terapia biológica surge como mais uma opção no tratamento desta e de outras doenças reumatológicas e baseia-se no reconhecimento de novos alvos fisiopatogênicos.…”

“…Manifestações mais graves, incomuns, mas cuja ocorrência não pode ser descartada, incluem anemia aplásica, síndrome mielodisplásica, pancitopenia e imunossupressão. 5,8 possible and still supposed ability to act as a rescue agent for nephritis and hemolytic lupus anaemia, simultaneously, with effectiveness and safety. This article presents the case of female lupus patient with both severe refractory hematologic disorder and renal impairment, which had an evolution of the simultaneous restoration of urine output, and clinical and laboratory improvement of autoimmune anaemia after rituximab administration.…”