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1.
Perfusion ; 38(8): 1746-1750, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-36128692

RESUMO

OVERVIEW: The use of extra-corporeal membrane oxygenation (ECMO) therapy to treat severe COVID-19 patients with acute respiratory failure is increasing worldwide. We reported herein the use of veno-venous ECMO in a patient with cold agglutinin haemolytic anaemia (CAHA) who suffered from severe COVID-19 infection. DESCRIPTION: A 64-year-old man presented to the emergency department (ED) with incremental complaints of dyspnoea and cough since one week. His history consisted of CAHA, which responded well to corticosteroid treatment. Because of severe hypoxemia, urgent intubation and mechanical ventilation were necessary. Despite deep sedation, muscle paralysis and prone ventilation, P/F ratio remained low. Though his history of CAHA, he still was considered for VV-ECMO. As lab results pointed to recurrence of CAHA, corticosteroids and rituximab were started. The VV-ECMO run was short and rather uncomplicated. Although, despite treatment, CAHA persisted and caused important complications of intestinal ischemia, which needed multiple surgical interventions. Finally, the patient suffered from progressive liver failure, thought to be secondary to ischemic cholangitis. One month after admission, therapy was stopped and patient passed away. CONCLUSION: Our case report shows that CAHA is no contraindication for VV-ECMO, even when both titre and thermal amplitude are high. Although, the aetiology of CAHA and its response to therapy will determine the final outcome of those patients.


Assuntos
Anemia Hemolítica , COVID-19 , Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório , Masculino , Humanos , Pessoa de Meia-Idade , COVID-19/complicações , COVID-19/terapia , Oxigenação por Membrana Extracorpórea/métodos , Síndrome do Desconforto Respiratório/terapia , Aglutininas
2.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 45(4): 689-694, 2023 Aug.
Artigo em Zh | MEDLINE | ID: mdl-37654151

RESUMO

Cold agglutinins(CA),autoantibodies against the antigen I or i on the surface of red blood cells,are mainly of IgM class,and the majority have κ light chains.They can lead to red blood cell agglutination at decreased body temperature and are usually associated with infections,drug reactions,autoimmune diseases,and hematological malignancies.However,solid tumors with CA are rare.We reported two cases of CA in the peripheral blood of patients with solid tumors.Peripheral complete blood cell count of the patients at admission showed reduced erythrocyte count and hematocrit,mismatching between erythrocyte count and hemoglobin,abnormally elevated levels of mean corpuscular hemoglobin and mean cell hemoglobin concentration.Peripheral blood smear showed erythrocyte aggregation.After the sample was preheated at 37 ℃ for 30 min,the reversibility of red blood cell aggregation was observed,and the erythrocyte parameters were corrected.


Assuntos
Autoanticorpos , Neoplasias da Mama , Neoplasias Ovarianas , Humanos , Autoanticorpos/isolamento & purificação , Feminino , Neoplasias da Mama/imunologia , Neoplasias Ovarianas/imunologia
3.
Eur J Haematol ; 109(1): 10-20, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35276014

RESUMO

INTRODUCTION: Autoimmune hemolytic anemia (AIHA) is considered a chronic disease, with an overall good prognosis. However, recent reports indicate pre-mature mortality. Causes of death have not been evaluated previously. METHODS: In a nationwide setting, we identified all patients with warm type AIHA or cold agglutinin disease (CAD), and age-sex-matched comparators from Denmark, 1980-2016. We estimated overall survival and cause-specific mortality from anemia, infection, cardiovascular causes, hematological or solid cancer, bleeding, or other causes, using cumulative incidence proportions. RESULTS: We identified 1460 patients with primary AIHA, 1078 with secondary AIHA, 112 with CAD, and 130 801 comparators. One-year survival and median survival were, 82.7% and 9.8 years for primary AIHA, 69.1% and 3.3 years for secondary AIHA, and 85.5% and 8.8 years for CAD. Prognosis was comparable to the general population only in patients with primary AIHA below 30 years. In all other age and subgroups, the difference was considerable. Cumulated cause-specific mortality at 1 year was increased among patients versus comparators. DISCUSSION: All groups of autoimmune hemolytic anemia are associated with increased overall and cause-specific mortality compared to the general population. This probably reflects unmet needs in both treatment and follow-up programs.


Assuntos
Anemia Hemolítica Autoimune , Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/epidemiologia , Anemia Hemolítica Autoimune/terapia , Seguimentos , Humanos , Prognóstico
4.
J Appl Microbiol ; 132(2): 841-854, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34416098

RESUMO

Patents of lectins with antiviral, antibacterial and antifungal applications were searched and reviewed. Lectins are proteins that reversibly bind to specific carbohydrates and have the potential for therapy of infectious diseases as biopharmaceuticals, biomedical tools or in drug design. Given the rising concerns over drug resistance and epidemics, our patent review aims to add information, open horizons and indicate our view of the future perspectives about the antimicrobial applications of lectins. Patents with publications until December 2020 were retrieved from Espacenet using defined search terms and Boolean operators. The documents were used to identify the geographical and temporal distribution of the patents, characterize their lectins, and classify and summarize their antiviral, antibiotic and antifungal applications. Lectins are promising antiviral agents against viruses with epidemics and drug resistance concerns. Mannose-binding lectins were the most suggested antiviral agents since glycans with mannose residues are commonly involved in viral entry mechanisms. They were also immobilized onto surfaces to trap viral particles and inhibit their spread and replication. Many patents described the extraction, isolation, amino acid and nucleotide sequences, and expression vectors of lectins with antibiotic and/or antifungal activities in terms of MIC and IC50 for in vitro assays. The inventions also included lectins as biological tools in nanosensors for antibiotics susceptibility tests, drug-delivery systems for the treatment of resistant bacteria, diagnostics of viral diseases and as a vaccine adjuvant. Although research and development of new medicines is highly expensive, antimicrobial lectins may be worth investments given the emergence of epidemics and drug resistance. For this purpose, less invasive routes should be developed as alternatives to the parenteral administration of biologics. While anti-glycan neutralizing antibodies are difficult to develop due to the low immunogenicity of carbohydrates, lectins can be produced more easily and have a broad-spectrum activity. Protein engineering technologies may make the antimicrobial applications of lectins more successful.


Assuntos
Anti-Infecciosos , Doenças Transmissíveis , Adjuvantes de Vacinas , Antibacterianos , Anti-Infecciosos/farmacologia , Doenças Transmissíveis/tratamento farmacológico , Humanos , Lectinas
5.
Scand J Clin Lab Invest ; 81(7): 598-600, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34346820

RESUMO

Cold agglutinins (CA) in blood may cause false reduction in red blood cell (RBC) count and false increases of RBC indices, such as mean corpuscular haemoglobin concentration (MCHC). Preheating at 37 °C for 2 h is used to overcome this problem. We previously proposed the integration in a total laboratory automation (TLA) setting of a customized reflex test in the presence of MCHC >385 g/L for identifying spurious elevations due to CA. Here, we prospectively evaluate this approach after its introduction in our clinical practice. We evaluated 73 consecutive blood samples from 34 adult patients. Short heating (<1 min) at 41 °C using the reticulocyte channel of Sysmex XN-9000 platform was followed by calculation of optical parameters by the instrument software to ensure quick solution of the CA-dependent problems. After the reflex test in the reticulocyte channel, MCHC dropped below 385 g/L in 50 samples. The reflex markedly corrected the RBC number in eight samples obtained from three patients with CA condition. Two samples from markedly anaemic patients had low blood haemoglobin and RBC count before and after reflex. The remaining 13 samples were obtained from 12 patients, most of whom were on antiretroviral therapy or suffered severe electrolyte disorders, known conditions associated to increased MCHC. The implementation of the proposed automatic reflex by reticulocyte channel on the Sysmex XN-9000 platform in a TLA setting may solve the problem of spuriously high MCHC due to RBC agglutination for CA in a few minutes instead of waiting hours for sample preheating.


Assuntos
Índices de Eritrócitos , Reflexo/fisiologia , Adulto , Anemia Hemolítica Autoimune/sangue , Crioglobulinas/metabolismo , Eritrócitos/metabolismo , Humanos
6.
J Clin Lab Anal ; 35(8): e23894, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34216510

RESUMO

BACKGROUND: Autoimmune hemolytic anemia (AIHA) is a rare disease characterized by hemolysis caused by autoantibodies against erythrocyte surface antigen. These antibodies can be classified as warm, cold, or mixed types. METHODS: We report two cases of cold agglutinin disease (CAD), which were eventually diagnosed owing to blood group discrepancy. Resolution was achieved after washing the red blood cells (RBCs) with warm saline and absorbing the autoantibodies at 4°C with the washed RBCs. We also assessed the patient's condition and discussed the strategy of blood transfusion. RESULTS: The first case occurred after postoperative chemotherapy for rectal cancer, and the other manifested with anemia from the outset. Direct antiglobulin tests were positive and revealed autoantibodies against C3d only. Cold agglutinin titration was performed, and the titers of both were 1:1024. Eventually, the patient's condition stabilized without blood transfusion. CONCLUSION: The serological discrepancies observed in the blood transfusion department can successfully guide blood transfusion decisions in cases of CAD.


Assuntos
Anemia Hemolítica Autoimune/sangue , Transfusão de Sangue , Idoso , Anemia Hemolítica Autoimune/terapia , Autoanticorpos/sangue , Teste de Coombs , Crioglobulinas/imunologia , Eritrócitos/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia
7.
J Clin Lab Anal ; 35(3): e23695, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33543811

RESUMO

Anti-human globulin (AHG) reagents are widely applied in pretransfusion compatibility tests. The accuracy of detection with AHG reagents is mainly affected by irregular antibodies or cold agglutinins in blood samples, which are related to the human complement system. Although much has been written about various types and applications of AHG reagents, their characteristics, interference factors and optimal selection in pretransfusion compatibility tests still need to be further clarified. Here, we review clinical practice and basic studies that describe each AHG reagent, summarize the advantages and disadvantages of using different AHG reagents in the presence of cold agglutinins or complement-fixing antibodies, explore the potential mechanisms by which the complement system influences detection with AHG reagents and address the question of how to optimally select AHG reagents for clinically significant antibody detection.


Assuntos
Tipagem e Reações Cruzadas Sanguíneas/métodos , Indicadores e Reagentes , Soroglobulinas/imunologia , Aglutininas , Teste de Coombs , Humanos , Imunoglobulina G/imunologia
8.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 507-512, 2021 Aug.
Artigo em Zh | MEDLINE | ID: mdl-34494519

RESUMO

Objective To explore the feasibility of preheating in 41 ℃ water bath for 30 minutes to correct the red blood cell parameters in the specimens containing high-titer cold agglutinins(CAs). Methods Two specimens containing high-titer CAs were selected during work,and the parameters of complete blood count at room temperature or after preheating in 37 ℃ or 41 ℃ water bath were compared.The smears were stained,and the distribution of red blood cells was observed with a microscope.Further,74 specimens without CAs were collected for complete blood count,and then the test results at room temperature and after preheating at 41 ℃ were compared. Results At room temperature,the specimens containing high-titer CAs showed significantly reduced red blood cell count(RBC)and hematocrit(HCT),abnormally increased mean corpuscular hemoglobin(MCH)and mean cell hemoglobin concentration(MCHC),abnormal percents of hemoglobin(HGB)and RBC,and aggregation of a large number of red blood cells.After being preheated at 37 ℃ for a certain time,the specimens demonstrated obviously improved parameters while still aggregation of a small number of red blood cells.After being preheated at 41 ℃ for 30 minutes,the specimens showed significantly increased RBC,normal HCT,MCH,and MCHC,and evenly distributed red blood cells.The 74 specimens without CAs showed the comparability was ≥80% between room temperature and preheating at 41 ℃ for 30 minutes or 60 minutes. Conclusion We can preheat the specimens containing high-titer CAs in a water bath at 41 ℃ to obtain accurate red blood cell parameters.


Assuntos
Eritrócitos , Crioglobulinas , Contagem de Eritrócitos , Estudos de Viabilidade , Hematócrito
9.
J Extra Corpor Technol ; 50(2): 120-123, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29921992

RESUMO

Waldenström's Macroglobulinemia (WM) is a rare lymphoma caused by the overproduction of immunoglobulin M (IgM). The elevated level of IgM causes serum hyperviscosity, cold agglutinins, and cryoglobulinemia. Anemia is also present because of impaired production of erythrocytes. For these reasons, placing a patient with WM on cardiopulmonary bypass (CPB) requires careful preparation. In this case, the patient was a 73-year-old male with known Waldenström's disease who required coronary artery bypass graft surgery. This report details the perioperative considerations used for successful CPB on a Waldenström's patient. Critical to this case was the use of plasmapheresis before surgery. Temperature management and acid/base status were carefully controlled. A successful coronary revascularization surgery was performed. Many of the Wadenstrom's disease complications expected on CPB failed to materialize.


Assuntos
Ponte Cardiopulmonar , Ponte de Artéria Coronária , Macroglobulinemia de Waldenstrom , Idoso , Anticoagulantes/uso terapêutico , Viscosidade Sanguínea , Crioglobulinas/análise , Humanos , Hipotermia Induzida , Masculino
10.
J Extra Corpor Technol ; 50(3): 187-188, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30250347

RESUMO

A patient with known cold agglutinins requiring an aortic valve replacement was referred for surgery. Asanguinous, Del Nido cardioplegia was used for myocardial protection. Warm induction followed by cold infusion prevented any agglutination and eliminated the need for subsequent cardioplegia doses. Following the cross-clamp period, the heart returned to normal sinus rhythm without need for defibrillation. Postoperative ejection fraction and systolic function were normal.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Médicos e Cirúrgicos sem Sangue/métodos , Parada Cardíaca Induzida/métodos , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Anemia Hemolítica Autoimune , Estenose da Valva Aórtica/cirurgia , Soluções Cardioplégicas/uso terapêutico , Crioglobulinas , Feminino , Humanos
13.
Transfus Med Hemother ; 42(5): 328-32, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26696802

RESUMO

BACKGROUND: It is unclear why haemolysis may somewhat persist in patients with cold autoimmune haemolytic anaemia (cAIHA) at 37 °C (core temperature). METHODS: Seven patients with cAIHA were included in this study. Serological testing was performed using standard techniques. Bound autoantibodies (aab) on patients' RBCs were analysed by the direct antiglobulin test (DAT), dual antiglobulin test (DDAT) and flow cytometry (FC) using pre-warmed RBCs (37 °C). Temperature-dependent complement binding was determined by incubation of patients' serum samples with group O RBCs and fresh serum complement. RESULTS: The DAT was strongly positive with anti-C3d in all cases, independent of season and outside temperature. Haemolysis usually improved during warm periods of time, but decompensated following febrile infections, and persisted throughout the year, though exposure to the cold was strictly avoided. In addition, trace amounts of IgM aab were infrequently detectable on patients' RBCs even at 37 °C, and complement activation was demonstrated following incubation of RBCs with the causative aab at 37 °C. CONCLUSIONS: Binding of trace amounts of IgM aab at 37 °C may provide an explanation for the durable C3d-positive DAT and haemolysis in patients with cAIHA.

14.
Angew Chem Int Ed Engl ; 53(41): 10899-903, 2014 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-24923471

RESUMO

An accelerated modular synthesis produced 18 amphiphilic Janus glycodendrimers with three different topologies formed from either two or one carbohydrate head groups or a mixed constellation with a noncarbohydrate hydrophilic arm. By simple injection of their THF solutions into water or buffer, all of the Janus compounds self-assembled into uniform, stable, and soft unilamellar vesicles, denoted glycodendrimersomes. The mixed constellation topology glycodendrimersomes were demonstrated to be most efficient in binding plant, bacterial, and human lectins. This evidence with biomedically relevant receptors offers a promising perspective for the application of such glycodendrimersomes in targeted drug delivery, vaccines, and other areas of nanomedicine.


Assuntos
Dendrímeros/química , Polissacarídeos/química , Lipossomas Unilamelares/química , Carboidratos/química , Humanos , Interações Hidrofóbicas e Hidrofílicas , Lectinas/química , Ligantes , Nanomedicina
15.
J Anaesthesiol Clin Pharmacol ; 30(1): 89-90, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24574601

RESUMO

We report a case of pseudo-thrombocytopenia due to cold agglutinins against platelets. These cold agglutinins were the cause for diagnostic confusion and resulted in extensive workup and unnecessary therapeutic precautions. A thirty two year old female with Guillain-Barre syndrome was admitted in the ICU and serial work-up showed markedly low levels of platelets. The patient had no symptoms of bleeding and patient was investigated extensively for deciphering the etiology of low platelet count. In-vitro clumping of platelets was suspected and in-vitro studies showed marked clumping of platelets with ethylene-diamine-tetra-acetic acid, citrate and heparinized samples. The manual platelet count was found to be within normal limits. Thrombocytopenia as a result of platelet cold agglutinins is a rare cause of in-vitro low platelet counts. No clinical problems have been reported due to the same.

16.
Cureus ; 16(6): e62466, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39015870

RESUMO

Secondary cold agglutinin autoimmune hemolytic anemia (AIHA) occurs most commonly due to infectious causes like Mycoplasma pneumonia and, more rarely, Epstein-Barr virus(EBV). Here we present a case of a 69-year-old female presenting with generalized weakness, who was found to have cold agglutinin hemolytic anemia. She unfortunately experienced some of the most severe complications of the disease including encephalopathy, hypoxia, and dry necrosis of peripheral extremities. Further investigation revealed an EBV infection, the rarest infectious cause of cold AIHA. She was started on steroids, the mainstay of treatment, but continued to worsen over the course of her extensive stay in the intensive care unit (ICU). Given the severity of the disease, the decision was made to use plasmapheresis and rituximab, the monoclonal antibody directed against CD20, as an experimental therapy. After adjunctive therapy was initiated, the patient began to clinically improve and ultimately made a full recovery. Rituximab is historically only effective in primary cold AIHA, but it appeared to elicit significant clinical improvement with our use in secondary cold AIHA. While there have been a handful of studies demonstrating its successful use in secondary cold AIHA, we propose that this medication be further studied to prevent the significant morbidity and mortality associated with the disease.

17.
Ann Card Anaesth ; 26(2): 223-226, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37706393

RESUMO

The term "cold agglutinin (CA)" refers to a group of disorders caused by anti-erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4°C-18°C). CAs contribute to 10 to 15% of autoimmune hemolytic anemia. We report a case of CAs diagnosed intraoperatively during emergency mitral valve replacement.


Assuntos
Anemia Hemolítica Autoimune , Ponte Cardiopulmonar , Humanos , Temperatura Baixa , Crioglobulinas , Autoanticorpos
19.
Mater Sociomed ; 34(4): 301, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36936896

RESUMO

Background: According to the literature, Cryoglobins, Cold Agglutinins, Donath-Landsteiner antibodies, and Cryofibrinogen arethe 4 types of Cold-Reactive proteins described. Objective: The aim of the study was to show the role of these proteins cardiovascular surgery. Case presentation: A 57-year-old male patient with a history of myocardial infarction 6 years ago, heavy smoker until 1 year ago, with diabetes, was admitted to the hospital for a surgical confrontation of coronary disease. He reports that for1-month symptoms are deteriorating (NYHA III). The history of the patient does not include either hematopoietic system or connective tissue diseases or recent viral infection. Angiographic control showed total obstruction of the small branch. The patient underwent median sternotomy. Suspension of the left sternum. Mobilization of the left internal mammary artery. Concomitant reception of left great saphenous vein. Intubation of ascending aorta and right atrium - vena cava with acatheter of two steps. He was extubated at the 10th post-surgical hour. Smooth post-surgical progression, with no signs of brain, myocardial or renal failure. The patient was discharged on the 5th post-surgical day. Conclusion: Independently of the technique that is used, the systemic temperature must be maintained duringthe cardiopulmonary bypass above the temperature threshold activity of the cold-reactiveproteins.

20.
Pharmaceuticals (Basel) ; 15(2)2022 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-35215351

RESUMO

The present review summarizes the current knowledge concerning provenance, properties, physiological and therapeutic actions of elderberry and the bioactive molecules present in the plant, with emphasis on their action on female reproduction. Elderberry or black elder (Sambucus nigra L.) attracts attention due to its easy cultivation and high availability of bioactive compounds. Most of the available data concerning black elder's therapeutic action are focused on its effects such as activation of immune processes and anti-inflammatory processes (cytokine production, etc.) and regulation of hormones and their receptors in cancer cells. The effects of elderberry on reproduction have been poorly investigated so far. Nevertheless, conducted studies so far demonstrate the stimulatory influence of black elder extract and its constituents, such as rutin, anthocyanins and agglutinins, on the viability and steroidogenesis of healthy ovarian cells as well as their ability to promote apoptosis and reduce the viability and proliferation of ovarian cancer cells. Furthermore, the action of black elder extract and its constituent biomolecules, such as anthocyanins and lectins, on embryogenesis and the embryonal estradiol-estradiol receptor system have also been reported. The available information, despite limitations, suggest the applicability of black elder constituents for improvement of reproductive processes in animal biotechnology, animal production and assisted reproduction, as well as for prevention and treatment of reproductive disorders (including cancer) in veterinary and human medicine.

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