Transfusion support of autoimmune hemolytic anemia: how could the blood group genotyping help?

Kenz, Hanane El; Efira, André; Lê, Phu Quoc; Thiry, Claire; Valsamis, Joseph; Azerad, Marie‐Agnès; Corazza, Francis

doi:10.1016/j.trsl.2013.09.007

Cited by 26 publications

(21 citation statements)

References 19 publications

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“…In transfusion medicine, SNP typing is a powerful adjunct to serologic testing and is the best method for typing transfused patients . Recent study has shown that molecular matching of patients and RBC units reduced alloimmunization risks .…”

Section: Discussionmentioning

confidence: 99%

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A simple genotyping procedure without DNA extraction to identify rare blood donors

et al. 2015

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The procedure was optimized for simplicity of use in genotyping platform and would allow not only to supply antigen-matched products to recipients but also to find rare phenotypes. This methodology could also be useful for establishing a donor repository for human platelet antigens (HPA)-matched platelets since the same issues are involved for patients with neonatal alloimmune thrombocytopenia or post-transfusion purpura.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, the presence of antibodies is a limitation to haemagglutination which is the traditional method for testing donor and patient blood group antigens and irregular antibodies. To overcome this problem, genotyping tests have been developed and their benefit in patients care has been reported in a number of clinical setting .…”

Section: Introductionmentioning

confidence: 99%

A simple genotyping procedure without DNA extraction to identify rare blood donors

et al. 2015

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“…In less urgent cases, an extended phenotyping is advisable and compatible red cell units may be selected for transfusion. 77 In some patients, more complex procedures, such as warm autoadsorption or allogeneic adsorption, may be needed for the detection of alloantibodies.…”

Section: Supportive Therapymentioning

confidence: 99%

Treatment of autoimmune hemolytic anemias

2014

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Autoimmune hemolytic anemia (AIHA) is a relatively uncommon disorder caused by autoantibodies directed against self red blood cells. It can be idiopathic or secondary, and classified as warm, cold (cold hemagglutinin disease (CAD) and paroxysmal cold hemoglobinuria) or mixed, according to the thermal range of the autoantibody. AIHA may develop gradually, or have a fulminant onset with life-threatening anemia. The treatment of AIHA is still not evidence-based. The first-line therapy for warm AIHA are corticosteroids, which are effective in 70-85% of patients and should be slowly tapered over a time period of 6-12 months. For refractory/relapsed cases, the current sequence of second-line therapy is splenectomy (effective approx. in 2 out of 3 cases but with a presumed cure rate of up to 20%), rituximab (effective in approx. 80-90% of cases), and thereafter any of the immunosuppressive drugs (azathioprine, cyclophosphamide, cyclosporin, mycophenolate mofetil). Additional therapies are intravenous immunoglobulins, danazol, plasma-exchange, and alemtuzumab and high-dose cyclophosphamide as last resort option. As the experience with rituximab evolves, it is likely that this drug will be located at an earlier point in therapy of warm AIHA, before more toxic immunosuppressants, and in place of splenectomy in some cases. In CAD, rituximab is now recommended as first-line treatment. ABSTRACT Treatment of warm AIHAThe traditional treatment of AIHA includes corticosteroids, splenectomy and conventional immunosuppressive drugs. Over recent years, some new therapies have become available and there has been some evidence of success. These therapies are primarily used in patients who are not candidates for or fail to respond to splenectomy, those who relapse after splenectomy, and those who cannot maintain stable hemoglobin levels without unacceptably high doses of corticosteroids. First-line therapy CorticosteroidsThere is general agreement that corticosteroids represent the first-line treatment for patients with warm antibody type AIHA, albeit their use is based on experience rather than hard evidence. In fact, there is little published information on their effectiveness, 1,16,17 and this is not supported by clinical trials. Corticosteroids, usually prednisone, are given at the initial dose of 1.0-1.5 mg/kg/day for 1-3 weeks until hemoglobin levels greater than 10 g/dL are reached. Response occurs mainly during the second week, and if none or minimal improvement is observed in the third week, this therapy is assumed to be ineffective. After stabilization of hemoglobin, prednisone should be gradually and slowly tapered off at 10-15 mg weekly to a daily dose of 20-30 mg, then by 5 mg every 1-2 weeks until a dose of 15 mg, and subsequently by 2.5 mg every two weeks with the aim of withdrawing the drug. Although one might be tempted to discontinue steroids more rapidly, AIHA patients should be treated for a minimum of three or four months with low doses of prednisone (≤10 mg/day).1 In fact, patients receiving low doses of cortico...

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“…68,69 In less urgent cases an extended phenotyping is advisable and the best compatible red cell units should be selected. 70 To minimize risks of febrile non-hemolytic reactions due to anti-leukocyte antibodies, leuko-depleted red cells are nowadays recommended in AIHA patients. As regards the volume to be transfused, it is worth reminding that overtransfusion (with an increased mass of RBCs available for destruction) should be avoided, particularly in elderly patients.…”

Section: Supportive Therapymentioning

confidence: 99%

Immune Hemolysis: Diagnosis and Treatment Recommendations

Barcellini

2015

Seminars in Hematology

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Transfusion support of autoimmune hemolytic anemia: how could the blood group genotyping help?

Cited by 26 publications

References 19 publications

A simple genotyping procedure without DNA extraction to identify rare blood donors

A simple genotyping procedure without DNA extraction to identify rare blood donors

Treatment of autoimmune hemolytic anemias

Immune Hemolysis: Diagnosis and Treatment Recommendations

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