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1.
Korean J Parasitol ; 58(5): 565-569, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33202509

RESUMO

This report describes the first clinical case of a transfusion-associated Mycoplasma haemocanis infection in a dog in Korea. A 6-year-old male Maltese underwent a red blood cell transfusion for idiopathic immune-mediated hemolytic anemia. Eighteen days after the blood transfusion, the recipient's packed cell volume decreased and basophilic organisms were found on erythrocytes. A polymerase chain reaction and sequential analysis showed that both the donor dog and recipient dog had M. haemocanis. Six weeks after doxycycline administration, no organisms were detected and the recipient's anemia had improved.


Assuntos
Anemia Hemolítica Autoimune/terapia , Anemia Hemolítica Autoimune/veterinária , Transfusão de Sangue/veterinária , Doenças do Cão/terapia , Doenças do Cão/transmissão , Doxiciclina/administração & dosagem , Infecções por Mycoplasma/transmissão , Infecções por Mycoplasma/veterinária , Mycoplasma , Reação Transfusional/microbiologia , Reação Transfusional/veterinária , Animais , Doenças do Cão/etiologia , Doenças do Cão/microbiologia , Cães , Masculino , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/microbiologia , República da Coreia , Resultado do Tratamento
2.
Rev Med Suisse ; 16(714): 2183-2187, 2020 Nov 11.
Artigo em Francês | MEDLINE | ID: mdl-33174702

RESUMO

Autoimmune hemolytic anemia is an uncommon disease that can be challenging to manage both for the emergency department physician and the general practitioner. The diagnosis is based on specific biological changes and on a positive direct Coombs test. Depending on the severity of the anemia and its clinical impact, an urgent blood transfusion can be required. However, ABO blood group typing and antibody screening may be impaired by autoantibodies. In case of vital need, a transfusion of ABO, Rh D and, if possible, C, c, E, e and Kell antigen matched red cells can be performed, before the complete achievement of the pre-transfusion testing. Further management includes the introduction of immunosuppression and the treatment of a possible underlying disease. Early contact with the hematologist, is strongly recommended.


Assuntos
Anemia Hemolítica Autoimune , Serviço Hospitalar de Emergência , Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/epidemiologia , Anemia Hemolítica Autoimune/terapia , Autoanticorpos , Tipagem e Reações Cruzadas Sanguíneas , Transfusão de Sangue , Teste de Coombs , Humanos
8.
BMJ Case Rep ; 13(3)2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32193179

RESUMO

Malignancies are often associated with autoimmune diseases, which are addressed by treating the underlying cancer. However, there are rare malignancies that can cause autoimmune diseases even after appropriate treatment. Our patient is a 39-year-old Hispanic man with a malignant thymoma recently treated with chemotherapy and radiation who presented with syncope and dyspnoea. He was found to be both anaemic and thrombocytopenic. His labs were consistent with autoimmune haemolytic anaemia (AIHA), except his reticulocyte count was unexpectedly low. Bone marrow biopsy supported a diagnosis of Evans syndrome, a rare autoimmune condition characterised by (AIHA) combined with immune thrombocytopenia. He was also found to have an acute parvovirus B19 infection. He was treated with steroids and RBC transfusion. His blood counts gradually returned to baseline, with improvement in symptoms. This patient's thymoma treatment and active parvovirus B19 infection likely both played a role in the development of Evans syndrome.


Assuntos
Anemia Hemolítica Autoimune/etiologia , Infecções por Parvoviridae/complicações , Trombocitopenia/etiologia , Timoma/complicações , Neoplasias do Timo/complicações , Adulto , Anemia Hemolítica Autoimune/terapia , Diagnóstico Diferencial , Transfusão de Eritrócitos , Glucocorticoides/uso terapêutico , Humanos , Masculino , Infecções por Parvoviridae/terapia , Parvovirus B19 Humano , Prednisona/uso terapêutico , Trombocitopenia/terapia , Timoma/terapia
9.
Medicine (Baltimore) ; 99(3): e18856, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011506

RESUMO

RATIONALE: Primary biliary cholangitis (PBC) is a rare autoimmune cholestatic liver disease. It is often associated with extrahepatic autoimmune disorders. However, the concurrence of PBC and Sjögren syndrome (SS) with the subsequent onset of autoimmune hemolytic anemia (AIHA) is extremely rare. PATIENT CONCERNS: This study investigated a 60-year-old woman admitted to our hospital with complaints of xerostomia for 5 years, pruritus for 3 years, and abnormal liver function for 3 months. DIAGNOSES: The patient was suffering from typical clinical PBC and SS, and developed decompensated liver cirrhosis after 32 months of ursodeoxycholic acid (UDCA) therapy. In May 2018, she was readmitted to the hospital with a high fever of 39 °C, coughing, and sever fatigue without remission after 3 days of cephalosporin antibiotic therapy. During the clinical course of PBC, her antimitochondrial antibodies (AMA) titers fluctuated from 1:1000 to negative and then to weakly positive, determined by indirect immunofluorescence (IIF), immunoblotting, and enzyme-linked immunosorbent assay (ELISA) based on recombinant mitochondrial antigens; furthermore, her titers of anti-gp210, an antinuclear antibody (ANA), increased sharply. Laboratory tests and imaging were performed to diagnose PBC and SS in September 2015. However, she was subsequently diagnosed with AIHA after 32 months of UDCA therapy based on the identification of pancytopenia, increased reticulocyte (RET) count, and a positive result from the direct Coombs test. INTERVENTIONS: UDCA, hepatic protectant, albumin infusion, chest drainage, rational antibiotic use, diuretics, and methylprednisolone were used to treat the patient. OUTCOMES: Liver cirrhosis was complicated by the development of AIHA, which became severe at 42 months of follow-up. LESSONS: This is the first case report showing a patient with comorbid PBC and SS, as well as the sequential development of AIHA with decreased AMA and increased anti-gp210 titers; this may have been due to immunodeficiency. These findings stress the importance of the serological screening of ANA profile, as well as repeated measurement of ANA and AMA to track PBC progression and prognosis.


Assuntos
Anemia Hemolítica Autoimune/imunologia , Autoanticorpos/imunologia , Colangite/imunologia , Mitocôndrias/imunologia , Complexo de Proteínas Formadoras de Poros Nucleares/imunologia , Síndrome de Sjogren/imunologia , Anemia Hemolítica Autoimune/terapia , Autoanticorpos/sangue , Colangite/terapia , Terapia Combinada , Feminino , Humanos , Cirrose Hepática Biliar/imunologia , Cirrose Hepática Biliar/terapia , Testes de Função Hepática , Pessoa de Meia-Idade , Complexo de Proteínas Formadoras de Poros Nucleares/sangue , Síndrome de Sjogren/terapia
10.
Medicine (Baltimore) ; 99(2): e18739, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914091

RESUMO

Autoimmune hemolytic anemia (AIHA) is a rare disease in which autoantibodies target red blood cells (RBCs), leading to anemia that ranges from no symptoms to severe life-threatening hemolysis. Little is known about the severity of anemia, blood transfusion efficiency and risk of transfusion-related reactions among hospitalized AIHA patients, especially in those with incompatible RBC transfusions.A retrospective study was conducted among hospitalized AIHA patients from January 2009 to December 2015 in a large tertiary care medical center in southwest China.A total of 450 AIHA hospitalized patients were recruited, of whom 97.3% had warm AIHA, 30.3% had primary AIHA, and 90.7% were treated with corticosteroids. On admission, approximately 3% of patients had an hemoglobin (Hb) <30 g/L, 34% had an Hb between 30 and 59.9 g/L, and 46% had an Hb ranging from 60 to 89.9 g/L. A total of 2509.5 U RBCs were transfused to AIHA patients, and 14 transfusion-related adverse reactions were recorded, without any hemolytic transfusion reactions. With an average transfusion trigger of 52.0 ±â€Š9.3 g/L, 59.7% of the patients received RBCs, and 55.8% of the transfusions were viewed as effective. Least incompatible RBCs were given in 39% of the transfusions, but the transfusion efficiency did not significantly decrease with these incompatible blood transfusions (P = .253). Primary AIHA patients with a nadir Hb of approximately 40 to 50 g/L during their hospital stay had the highest rate of remission and did not require a different total number of RBC transfusions (P = .068) or length of hospitalization (P = .194) compared to other groups with nadir Hb values <30 g/L, ≥30 and <40 g/L, ≥50 and <60 g/L, and ≥60 g/L.One-third of AIHA patients suffered from severe anemia during hospitalization, and transfusions, even with incompatible RBCs, were safe and efficient. However, transfusion triggers between 40 and 50 g/L seemed to benefit the most patients by alleviating the RBC destruction caused by autoantibodies, and a restrictive transfusion strategy was beneficial in AIHA patients.


Assuntos
Corticosteroides/uso terapêutico , Anemia Hemolítica Autoimune/fisiopatologia , Anemia Hemolítica Autoimune/terapia , Transfusão de Eritrócitos/métodos , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Anemia Hemolítica Autoimune/epidemiologia , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hemoglobinas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Reação Transfusional/epidemiologia
11.
Neurology ; 94(6): e635-e638, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-31852814

RESUMO

Our objective was to evaluate whether IV immunoglobulin (IVIg) increases the risk of thromboembolic events in neurology outpatients with inflammatory neuropathies, as there is conflicting evidence supporting this hypothesis, mainly from non-neurologic cohorts. We investigated this question over 30 months in our cohort of patients with inflammatory neuropathies receiving regular IVIg and found a greater incidence of arterial and venous thromboembolic events than population-based rates determined by hospital admissions data. Vascular risk factors were more common in the event group but there were no IVIg administration factors that contributed to the risk. This study suggests that IVIg may have a small but contributory role in determining thromboembolic risk in the inflammatory neuropathy cohort and more evidence is required before it is clear whether the current primary prevention guidelines are appropriate in this group of patients.


Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Polineuropatias/terapia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Tromboembolia/epidemiologia , Anemia Hemolítica Autoimune/terapia , Ataxia/terapia , Humanos , Incidência , Infarto do Miocárdio/epidemiologia , Oftalmoplegia/terapia , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neuropatia de Pequenas Fibras/terapia , Acidente Vascular Cerebral/epidemiologia , Síndrome da Veia Cava Superior/epidemiologia , Trombose Venosa/epidemiologia
12.
Rev Med Chil ; 147(7): 836-841, 2019 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-31859981

RESUMO

BACKGROUND: Autoimmune hemolytic anemia (AIHA) is an uncommon disease. In its presentation, it can be severe and even lethal. There is only one clinical report concerning this pathology in Chile. OBJECTIVE: To describe the clinical characteristics and evolution of adult AIHA inpatients. MATERIALS AND METHODS: Retrospective review of clinical records of adult AIHA inpatients between January 2010 and June 2018 was done. Demographic, clinical, laboratory and therapeutic information was analyzed. A descriptive, analytical and survival analysis was performed. RESULTS: Forty-three adult patients diagnosed with AHIA were hospitalized in a period of 8 years. Median age was 63 years (range 22-86 years), mostly women (72%). Warm antibodies were detected in 36 cases (84%) and cold antibodies in seven. Seventy two percent of the patients had an underlying cause, and 58% were secondary to lymphoproliferative neoplasms. All patients except two, received steroids as initial treatment, with response in 37 (90%) of them. Three refractory patients received rituximab, with response in all of them, and relapse in one. Median follow-up was 38 months (range 2-98 months). Five year overall survival was 72%. CONCLUSION: AHIA in adults inpatients is a heterogeneous disease, mainly due to warm antibodies, and to secondary etiology.


Assuntos
Anemia Hemolítica Autoimune/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Hemolítica Autoimune/mortalidade , Anemia Hemolítica Autoimune/terapia , Azatioprina/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rituximab/administração & dosagem , Esplenectomia , Análise de Sobrevida , Adulto Jovem
13.
Transfusion ; 59(12): 3575-3579, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31670408

RESUMO

BACKGROUND: Hemolytic disease of the fetus and newborn (HDFN) is due to passively transferred maternal antibodies directed against fetal red blood cell (RBC) antigens and can lead to severe morbidity and mortality. Anti-M is usually a naturally occurring antibody of low clinical significance, although occasionally severe cases of HDFN are seen. CASE REPORTS: Two M+ sisters are presented, each developing hemolysis during the first 2 weeks of life due to maternal anti-M, resulting in severe anemia and requiring blood transfusion. RBC agglutination was observed in peripheral blood samples of both infants at room temperature with dissociation at 37°C. Maternal anti-M detected by column indirect agglutination technique, was of low titer (1:16) and demonstrated low thermal amplitude, reacting in saline at 4°C but was not detectable in saline at 37°C. CONCLUSIONS: Anti-M of low thermal amplitude may cause hemolytic disease of the newborn with laboratory features resembling cold agglutinin disease.


Assuntos
Anemia Hemolítica Autoimune/terapia , Transfusão de Sangue/métodos , Imunoglobulina M/imunologia , Teste de Coombs , Eritroblastose Fetal , Feminino , Hemólise/fisiologia , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/metabolismo , Recém-Nascido , Temperatura
14.
J Coll Physicians Surg Pak ; 29(12): S106-S108, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779758

RESUMO

Celiac disease (CD) is an autoimmune disorder with high incidence of multi organ involvement; especially, gastrointestinal manifestations and an increased risk of malignancies. Here we report a case of CD with celiac hepatitis, autoimmune hemolytic anemia (AIHA) and Grave's disease (GD) with their complications. Polyautoimmunity requires comprehensive analysis. While CD and GD were previously diagnosed, AIHA and cirrhosis were diagnosed during admission upon extensive work-up. Similarly, other autoimmune etiologies, such as autoimmune hepatitis (AIH), and/or primary biliary cholangitis were ruled out. All three diseases were treated afresh with strict adherence to a gluten-free diet (GFD) and carbimazole along with addition of medications for cirrhosis complicated by ascites. This was a rare case where non-adherence to a GFD led to such severe adverse events. A case of celiac hepatitis presenting with such a wide array of signs and symptoms has rarely been reported in the literature and the management of this patient was unique and challenging.


Assuntos
Anemia Hemolítica Autoimune/complicações , Autoimunidade , Carbimazol/uso terapêutico , Doença Celíaca/complicações , Dieta Livre de Glúten/métodos , Doença de Graves/complicações , Hepatite Autoimune/complicações , Anemia Hemolítica Autoimune/imunologia , Anemia Hemolítica Autoimune/terapia , Antitireóideos/uso terapêutico , Biópsia , Doença Celíaca/imunologia , Doença Celíaca/terapia , Feminino , Doença de Graves/imunologia , Doença de Graves/terapia , Hepatite Autoimune/imunologia , Hepatite Autoimune/terapia , Humanos , Adulto Jovem
15.
Rinsho Ketsueki ; 60(9): 1100-1107, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597833

RESUMO

In 2017, The British Society of Haematology published new guidelines for the diagnosis and management of autoimmune hemolytic anemia (AIHA). Usually this is diagnosed using a combination of clinical and laboratory findings of hemolysis using the direct antiglobulin test (DAT). The revised guidelines propose several steps to evaluate and diagnose patients with unexplained hemolysis and a negative DAT, and they recommend screening for cold agglutinin disease (CAD) using a direct agglutination test (DAggT) before evaluating the cold agglutinin titer. Rituximab is becoming the preferred second-line choice for steroid-refractory warm AIHA and the first-line choice for primary CAD. Rituximab is an off-label drug for use in AIHA treatment in Japan, but in future will be used as standard therapy. Anti-C1s antibody is a new drug for CAD that has entered phase 3 trials.


Assuntos
Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/terapia , Testes de Aglutinação , Ensaios Clínicos Fase III como Assunto , Hemólise , Humanos , Uso Off-Label , Guias de Prática Clínica como Assunto , Rituximab/uso terapêutico
18.
Curr Oncol Rep ; 21(10): 87, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31414187

RESUMO

PURPOSE OF REVIEW: Discuss the pathophysiology, clinical presentation, diagnosis, and treatment of immune-mediated cytopenias (IMC) after hematopoietic cell transplantation (HCT). RECENT FINDINGS: Key risk factors for post-HCT IMC include younger age, non-malignant disease, and umbilical cord blood stem cell source. While anemia predominates, any or all three hematopoietic cell lines can be affected. In rare cases, IMC can cause graft failure or death. IMC is hypothesized to result from immune dysregulation upon reconstitution of donor hematopoietic cells (i.e., dysfunctional regulatory T cells). Aside from blood product transfusions, IMC treatment includes immune-suppressive or ablative agents. First-line therapies, including corticosteroids and intravenous immunoglobulin, are often inadequate, prompting use of additional agents aimed at antibody production/T cell dysfunction or direct antibody removal via plasmapheresis. IMC occurs in up to 20% of high-risk HCT populations. Morbidity and mortality from IMC post-HCT have been reduced by improved recognition and aggressive early interventions.


Assuntos
Anemia Hemolítica Autoimune/terapia , Doença Enxerto-Hospedeiro/terapia , Doenças Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pancitopenia/terapia , Trombocitopenia/terapia , Anemia Hemolítica Autoimune/etiologia , Anemia Hemolítica Autoimune/patologia , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/patologia , Doenças Hematológicas/imunologia , Doenças Hematológicas/patologia , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Pancitopenia/etiologia , Pancitopenia/patologia , Prognóstico , Trombocitopenia/etiologia , Trombocitopenia/patologia
20.
Transfus Clin Biol ; 26(3): 152-154, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31277985

RESUMO

The complement is a key player of the innate immune response. It provides defense mechanisms that are not specific, but very efficient at neutralizing any invader, accounting for 4% of the proteins in the peripheral blood. Nevertheless, there is a dark side to the complement system, as it may activate its machinery against healthy cells such as peripheral blood red blood cells and platelets resulting in undesired hemolysis and thrombocytopenia, respectively. Understanding and identifying the role of complement in these settings allow physicians to adjust their diagnostic and therapeutic modalities accordingly. The role of complement in the pathophysiology and management of autoimmune hemolytic anemia and of alloimmune-mediated thrombocytopenia is under investigation and discussed.


Assuntos
Anemia Hemolítica Autoimune/imunologia , Proteínas do Sistema Complemento/imunologia , Imunidade Inata/imunologia , Transfusão de Plaquetas , Anemia Hemolítica Autoimune/terapia , Especificidade de Anticorpos , Antígenos de Plaquetas Humanas/imunologia , Soro Antilinfocitário/sangue , Soro Antilinfocitário/imunologia , Autoanticorpos/sangue , Autoanticorpos/imunologia , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia
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