Classification and Clinical Characteristics of Autoimmune Hemolytic Anemias

Petz, Lawrence D.

doi:10.1016/b978-0-443-08559-8.50007-8

Cited by 15 publications

(17 citation statements)

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“…AIHA occurs most frequently in lymphoid neoplasms and CLL is the most common LPN associated with AIHA. [3] This is because, in B-cell neoplasms, there is production of autoantibodies by the malignant lymphocytes [8,12]. No positive DAT was seen in the group receiving chemotherapy; this may be due to the effect of chemotherapy on AIHA [23].…”

Section: Resultsmentioning

confidence: 99%

“…AIHA has an incidence of 1-3 cases per 100,000/year [1]. More than half the cases of AIHA are warm AIHA with an incidence of 1/50,000 -80,000 persons [3,4]. About 1 in 1,000 -36,000 healthy blood donors may have a positive DAT result [5].…”

Section: Introductionmentioning

confidence: 99%

“…Autoimmune haemolytic anaemia has been associated with mostly lymphoid malignancies like chronic lymphocytic leukaemia (CLL) than non-lymphoid or solid malignancies, however it has also been reported in solid tumours including renal cell carcinoma, Kaposi sarcoma, gastric cancers, cancers of the lungs, breasts, ovaries, colon, caecum, cervix, International Journal of TROPICAL DISEASE & Health hypernephroma and melanoma [15,16,17,18,19]. Up to a third of CLL patients have a positive DAT with 5-25% cases of CLL are associated with AIHA, usually by 4.1 years after the diagnosis of CLL was made [20,3]. The incidence of AIHA in non-Hodgkin's lymphoma (NHL) is reported to be 13.7% [21].…”

Section: Introductionmentioning

confidence: 99%

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Autoimmune Haemolytic Anaemia in Patients with Cancer Diagnoses

Korubo

Ejele

Nwauche

2019

JCTI

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Aims:To determine if AIHA plays a role in anaemia associated with malignancies, and ascertain the cancers in which AIHA occurs. Study Design: This was a cross-sectional case-control study. Place and Duration of Study: Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Rivers, Nigeria. Methodology: We conducted the study on patients with malignancies either on admission in the wards or attending follow up clinics. Healthy age/sex-matched subjects were used as controls. Cases with and without chemotherapy were analyzed as subgroups. Three hundred and seventysix (376) participants (188 cancer patients and 188 controls) were enrolled in the study. Full blood count, reticulocyte count, blood film, direct antiglobulin test (DAT), indirect antiglobulin test (IAT) and bilirubin assays were conducted on anticoagulated blood samples of all the patients and Original Research Article

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Autoimmune Haemolytic Anaemia in Patients with Cancer Diagnoses

Korubo

Ejele

Nwauche

2019

JCTI

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“…1 In warm AIHA, mainly polyclonal RBC autoantibodies of IgG class and sometimes of IgA class are involved and react optimally around 37°C. 2 Sensitization of RBC with this type of antibodies will lead to destruction via IgG-Fc receptors (FcγR) or IgA-Fc receptors (FcαR), respectively, on phagocytes, mainly in the spleen.…”

Section: Introductionmentioning

confidence: 99%

Complement deposition in autoimmune hemolytic anemia is a footprint for difficult-to-detect IgM autoantibodies

et al. 2015

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© F e r r a t a S t o r t i F o u n d a t i o nwhich leads to remission in 50% of patients. 7 Rituximab has also been seen to be a successful treatment for IgGmediated AIHA, 8 and -despite its high cost and side effects -is recommended as second-line therapy in steroid-refractory AIHA. Cold (IgM-mediated) AIHA usually does not respond to prednisone. In some cases hemolysis can be prevented by protection from cold, but otherwise the therapeutic anti-CD20 antibody rituximab seems to be a promising strategy for treatment of this group of patients, showing a response rate of around 50%. 9,10 In general, patients with mixed AIHA initially respond well to steroids, but usually go on to develop chronic hemolysis. 11,12 To determine the optimal therapy, it is crucial to identify the causative RBC autoantibodies correctly, and to evaluate the presence of anti-RBC IgM autoantibodies in AIHA. However, with the current diagnostic techniques, it can be challenging to detect IgM because of its frequently low avidity. Moreover, a distinction is not routinely made between IgG and IgM in the IAT and can be difficult. We, therefore, studied alternative methods to detect autoantibodies in AIHA, focusing on the detection of IgM. First, we adapted the DAT and IAT to a fluorescence-activated cell sorting (FACS)-based assay, since a similar strategy had previously been shown to be successful for the detection of IgG and C3 on RBC.13-16 Secondly, we studied a method for detecting IgM based on the presence of deposited complement factors on patients' RBC. It is known that IgM activates complement more efficiently than IgG and it has been shown that if a patient's serum induces hemolysis in vitro, this is often caused by anti- RBC IgM 17 . Instigated by this, we studied whether the presence or extent of complement C3 deposition, as routinely measured in the DAT, can indicate the presence of anti-RBC IgM by separating IgG and IgM in the sera from AIHA patients and subsequently testing which fractions of the samples activated complement. Methods Patients' materialFor the FACS-based IAT and DAT studies, anonymized residual samples from patients with AIHA (34 and 50 patients, respectively) were used. The samples were collected in 2013 and 2014 and had been sent in for diagnostic tests to the Dutch reference laboratory for immunohematology and had a positive DAT for at least C3d and positivity in the hemolysin test. For the fractionation/depletion experiments, 16 additional samples were used that were positive for at least C3d in the DAT. Details can be found in Online Supplementary Table S1. The presence of clinical hemolysis was confirmed using the following parameters, if available: low hemoglobin, high lactate dehydrogenase, decreased haptoglobin, increased indirect bilirubin or a confirmed diagnosis by the treating physician.Fractionation of serum or eluate from patients with autoimmune hemolytic anemia AIHA patients' serum, recalcified plasma or eluate was filtered through a 0.22 μm filter before loading 0.5 mL on a 10/30...

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“…AIHA is classified into warm and cold reactive antibody types. 1 Cold agglutinin disease (CAD) has traditionally been classified into a primary or idiopathic type not associated with lymphoma or other diseases and a secondary type accompanied by malignant disease, most often lymphoma. 2 The term "cold" is primarily derived from the immune biology of CAD, not from clinical features of patients.…”

Section: Introductionmentioning

confidence: 99%