Plasma exchange for a hemolytic crisis due to autoimmune hemolytic anemia of the IgG warm type

Garelli, S.; Mosconi, L; Valbonesi, M; Schieppati, G.; Navassa, G

doi:10.1007/bf01035494

Cited by 24 publications

(13 citation statements)

References 10 publications

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“…Some isolated cases of AIHA treated with PEx in adults and children have been published, and the results have been inconclusive [7][8][9][10][11][12][13][14][15][16][17]. As indicated in a recent review [18], concomitant therapy with steroids and immunosuppressive agents often obscures the contribution of PEx to the outcome.…”

Section: Discussionmentioning

confidence: 98%

Plasma exchanges do not increase red blood cell transfusion efficiency in severe autoimmune hemolytic anemia: A retrospective case-control study

et al. 2006

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Severe autoimmune hemolytic anemia (AIHA) can cause life-threatening hemolysis requiring red blood cell transfusions (RBT). The efficiency of RBT could be improved with the use of plasma exchanges (PEx) before RBT. The objective of this study was to assess the effectiveness of PEx in severe AIHA of adults. All adult patients with severe AIHA requiring RBT were included in this single center retrospective case-control study. The end point was change in hemoglobin (Hb) level after RBT, depending on whether PEx was done (experimental group) or not (control group). Thirty-one sessions of RBT following PEx were performed on the 5 patients of the experimental group and were compared with the 7 sessions of BT without PEx performed on the 4 patients of the control group. Despite a lower mean Hb value before the session of RBT (5.7 g/dl vs. 7.2 g/dl, P = 0.04) in the control group, the mean Hb value 5 (4-7) days following RBT (8.7 g/dl vs. 8.6 g/dl, P = 0.85) was not different in the experimental and in the control group, respectively. In a second analysis in which each patient was his own control (31 sessions of RBT following PEx vs. 51 sessions of RBT alone), the gain in Hb was not different (1.4 g/dl vs. 1.9 g/dl, P = 0.67). When RBT are required in severe AIHA of adults, the use of a single PEx before BT does not increase the efficiency of RBT based on day 5 evaluation.

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Section: Discussionmentioning

confidence: 98%

Plasma exchanges do not increase red blood cell transfusion efficiency in severe autoimmune hemolytic anemia: A retrospective case-control study

et al. 2006

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“…In some instances, responses have been described [166][167][168][169]. Therefore, plasmapheresis may be an alternative treatment (experimental therapy) for patients who did not show a response to first-and second line therapies.…”

Section: Treatment Of Cold Antibody Aihamentioning

confidence: 94%

“…In some patients with AIHA presenting with cold antibodies, with the Donath-Landsteiner antibody, but also in cases with WA-AIHA, plasmapheresis has been suggested as a therapeutic manoeuvre [95,[166][167][168][169]. In some instances, responses have been described [166][167][168][169].…”

Section: Treatment Of Cold Antibody Aihamentioning

confidence: 97%

Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review

Valent

Lechner

2008

Wien Klin Wochenschr

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Autoimmune haemolytic anaemia (AIHA) is an immune disorder caused by antibodies directed against unmodified autologous red cells. The disorder may be a primary (idiopathic) or a secondary disease. The diagnosis is based on the presence of anaemia, signs of haemolysis with reticulocytosis, low haptoglobin, increased lactate dehydrogenase, elevated indirect bilirubin, and a positive direct antiglobulin test (Coombs test). Sometimes, not all of these typical features are present. Most AIHA are caused by warm antibodies, whereas cold antibodies are less commonly detected. While half of the warm antibody-based AIHA are idiopathic anaemias, almost all cold antibody AIHA are secondary anaemias. Underlying diseases are Non Hodgkin's lymphomas and systemic autoimmune disorders, and less frequently organ transplantation, infections, or solid tumors. Moreover, AIHA is an important complication of treatment with nucleoside analogs. Most patients with AIHA require therapy. In warm antibody AIHA, standard first line therapy are glucocorticosteroids with or without high dose immunoglobulins, whereas splenectomy is considered second-line therapy. Response rates of primary AIHA to corticosteroid therapy are high. After initial remission, the dose should be tapered down slowly and with caution, and in some cases, low-dose maintenance therapy is required. The efficacy of standard therapy is low in secondary AIHA that develops in lymphoma patients, posttransplant patients, or tumor patients. Among other immunosuppressive treatments, rituximab (anti-CD20) appears to be highly effective in patients with warm antibody AIHA refractory to standard therapy. Mycophenolate mofetil is quite effective in AIHA patients with an underlying autoimmune or lymphoproliferative disease. Patients with cold agglutinins are refractory to steroids and splenectomy. Half of these patients may respond to rituximab, although responses usually are short-lived. Sometimes, AIHA that is associated with malignant lymphomas or tumors, disappears after successful anti-lymphoma or anti-tumor therapy.

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“…The role of plasmapheresis in the treatment of several immune-complex disorders is well accepted, but in the field of antibody-mediated hematologic disorders, plas ma exchange (PE) has been used with controversial results [1,2], In patients with autoimmune hemolytic anemia (AIHA) of the cold antibody type PE has been employed in occasional cases with little efficiency [3][4][5][6], on the other hand, it had some benefit in AIFIA of the warm antibody type [7][8][9][10][11]. We here report on an additional case with beneficial effect of PE in a black patient with sickle cell trait, who developed an extremely severe form of AIHA of the warm antibody type with acute renal failure, refractory to conventional treatment with corti costeroids.…”

Section: Introductionmentioning

confidence: 99%

Plasma Exchange Treatment in Autoimmune Hemolytic Anemia of the Warm Antibody Type with Renal Failure

Keyserlingk¹,

Meyer-Sabellek²,

Arntz³

et al. 1987

Vox Sanguinis

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A patient with autoimmune hemolytic anemia of the warm antibody type developed a hyperacute hemolytic crisis with acute renal failure under conventional treatment with corticosteroids. Because of the life-threatening situation it was decided to start a combined treatment with immunosuppression and plasmapheresis. Already after the first plasma exchange the direct antiglobulin test became weakly positive, the hemoglobin level rose from 4.1 to 8.1 g/dl, and the hemolytic crisis subsided. Four more exchanges were performed; thereafter, the patient’s clinical condition and laboratory data stabilized.

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Plasma exchange for a hemolytic crisis due to autoimmune hemolytic anemia of the IgG warm type

Cited by 24 publications

References 10 publications

Plasma exchanges do not increase red blood cell transfusion efficiency in severe autoimmune hemolytic anemia: A retrospective case-control study

Plasma exchanges do not increase red blood cell transfusion efficiency in severe autoimmune hemolytic anemia: A retrospective case-control study

Diagnosis and treatment of autoimmune haemolytic anaemias in adults: a clinical review

Plasma Exchange Treatment in Autoimmune Hemolytic Anemia of the Warm Antibody Type with Renal Failure

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