Predictors of autoimmune hemolytic anemia in beta-thalassemia patients with underlying red blood cells autoantibodies

Khaled, Monia Ben; Ouederni, Monia; Sahli, Nessrine; Dhouib, N.; Abdelaziz, Ahmed Ben; Rekaya, Samia; Kouki, Ridha; Kâabi, H.; Hmida, Slama; Mellouli, Fethi; Béjaoui, Mohamed

doi:10.1016/j.bcmd.2019.102342

Cited by 14 publications

(17 citation statements)

References 28 publications

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“…In our study, we found that LRBCs are able to decrease incidences of AEs with beneficial effects on RBC count and total bilirubin. These findings correspond with previous observational studies which had found that leukoreduced blood offers some protective benefits against hemolysis in certain AIHA patients [58]. Additionally, our results showed that WRBCs may have greater efficacy on improving RBC count, hemoglobin count and reticulocyte percentage, as well as yielding a greater reduction in AEs compared with LRBCs.…”

Section: Discussionsupporting

confidence: 92%

Transfusion of Modified Blood Components for the Treatment of Autoimmune Hemolytic Anemia: A Network Meta-Analysis

et al. 2021

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Aim: To evaluate the efficacy and safety of transfusing leukoreduced red blood cells (LRBCs) and/or washed RBCs (WRBCs) in treating adult patients with autoimmune hemolytic anemia. Materials & methods: Randomized control trials were included. Outcomes were response incidence, hematological parameters (HPs) and adverse event (AE) incidence. Results: 16 randomized control trials (n = 1061) were included. LRBC+WRBC yielded increased response incidence and improvements in HP compared with suspended RBCs (SRBCs). WRBCs improved HP while LRBCs only improved RBC count and total bilirubin. LRBCs and WRBCs both reduce AE incidences compared with SRBCs. Conclusion: Modified blood components may achieve increased response incidence and/or HP, as well as decreased AE compared with SRBCs.

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Section: Discussionsupporting

confidence: 92%

Transfusion of Modified Blood Components for the Treatment of Autoimmune Hemolytic Anemia: A Network Meta-Analysis

et al. 2021

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“…Most studies are focused on alloAbs in transfused patients and report the presence of autoAbs in this context. Notably, all the reports except for one in β-thalassemia [ 17 ] evaluated the frequency of autoAbs rather than that of AIHA. Finally, only one study from our group evaluated the presence of autoAbs in HS, by using the more sensitive mitogen-stimulated DAT [ 11 , 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…Overall, autoAb frequency ranges from 1% to 28.2% in β-thalassemia [ 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ], from 0.8% to 42% in SCD [ 27 , 28 , 29 , 30 ], and reaches 61% in HS (likely due to more sensitive technique) [ 11 ]. Few data are available about the Ab type, with warm antibodies (IgG+) being reported in half of the DAT-positive cases, IgG+ complement (C)—in approximately one third of cases, and C+—in the remaining cases.…”

Section: Resultsmentioning

confidence: 99%

“…Studies are consistent in identifying alloAbs, transfusion exposure, and splenectomy as risk factors for the development of autoAbs. Interestingly, only two observational studies and a few case reports evaluated clinically relevant AIHA, with the prevalence ranging from 1.8% to 6.4% [ 17 , 28 ]. The majority of autoAbs were warm, with or without complement fixation.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of autoAbs were warm, with or without complement fixation. A recent longitudinal study by Khaled et al showed that 25 subjects developed AIHA among 385 β-thalassemia pediatric patients [ 17 ]. All the patients were transfusion-dependent, and the frequency of AIHA was inversely proportional to the number of blood transfusions received.…”

Section: Resultsmentioning

confidence: 99%

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Autoimmune Hemolytic Anemia as a Complication of Congenital Anemias. A Case Series and Review of the Literature

Motta

Giannotta

Ferraresi

et al. 2021

JCM

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Congenital anemias may be complicated by immune-mediated hemolytic crisis. Alloantibodies are usually seen in chronically transfused patients, and autoantibodies have also been described, although they are rarely associated with overt autoimmune hemolytic anemia (AIHA), a serious and potentially life-threatening complication. Given the lack of data on the AIHA diagnosis and management in congenital anemias, we retrospectively evaluated all clinically relevant AIHA cases occurring at a referral center for AIHA, hemoglobinopathies, and chronic hemolytic anemias, focusing on clinical management and outcome. In our cohort, AIHA had a prevalence of 1% (14/1410 patients). The majority were warm AIHA. Possible triggers were recent transfusion, infection, pregnancy, and surgery. All the patients received steroid therapy as the first line, and about 25% required further treatment, including rituximab, azathioprine, intravenous immunoglobulins, and cyclophosphamide. Transfusion support was required in 57% of the patients with non-transfusion-dependent anemia, and recombinant human erythropoietin was safely administered in one third of the patients. AIHA in congenital anemias may be challenging both from a diagnostic and a therapeutic point of view. A proper evaluation of hemolytic markers, bone marrow compensation, and assessment of the direct antiglobulin test is mandatory.

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Comprehensive management of refractory autoimmune hemolytic anemia in pediatric beta-thalassemia major patient: A case report

William

Rusmawatiningtyas

Makrufardi

et al. 2021

Annals of Medicine and Surgery

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Introduction and importance: Autoimmune hemolytic anemia (AIHA) is characterized by the production of antibodies against the red blood cells (RBCs) leading to increased hemolysis. Incidence of AIHA in patients with beta-thalassemia major is 5 of 100 thalassemia patients. Case presentation A 15-year-old female patient with refractory AIHA and thalassemia was unresponsive to steroid therapy. In this report, she was treated with cyclosporine and prednisone in addition to leucodepleted packed red cell (PRC). She was successfully got remission during one-year monitoring. Clinical discussion Cyclosporine is an immunosuppressive agent that interferes with T-cells activation by inhibiting transcription of cytokines, such as interleukin 2 and interferon-ɣ. Cyclosporine and steroid have synergic effects to prevent antibody production. Nephrotoxicity is one of the most concerning effect in cyclosporine usage, but it rarely develops using doses lower than 5 mg/kgBW/day. In limited resources blood bank with ABO and Rh crossmatch only, leucodepleted PRC transfusion could be an effective way to prevent antibody formation to minor blood group. Conclusion Cyclosporine and steroid could be considered for management in refractory AIHA with thalassemia patients. Non-pharmacological therapy such as leucodepleted PRC transfusion and limited donor transfusion could be considered.

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Predictors of autoimmune hemolytic anemia in beta-thalassemia patients with underlying red blood cells autoantibodies

Cited by 14 publications

References 28 publications

Transfusion of Modified Blood Components for the Treatment of Autoimmune Hemolytic Anemia: A Network Meta-Analysis

Transfusion of Modified Blood Components for the Treatment of Autoimmune Hemolytic Anemia: A Network Meta-Analysis

Autoimmune Hemolytic Anemia as a Complication of Congenital Anemias. A Case Series and Review of the Literature

Comprehensive management of refractory autoimmune hemolytic anemia in pediatric beta-thalassemia major patient: A case report

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