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1.
J Med Case Rep ; 14(1): 246, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33339534

RESUMO

BACKGROUND: In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events. CASE PRESENTATION: We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury. CONCLUSIONS: Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).


Assuntos
Anemia Hemolítica Autoimune/sangue , Infecções Assintomáticas , Proteína C-Reativa/imunologia , Interleucina-6/imunologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Idoso de 80 Anos ou mais , Anemia Hemolítica Autoimune/tratamento farmacológico , Anemia Hemolítica Autoimune/etiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , /tratamento farmacológico , Teste de Coombs , Eletrocardiografia , Inibidores Enzimáticos/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Prednisolona/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
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
3.
Artigo em Inglês | MEDLINE | ID: mdl-33027391

RESUMO

Asymptomatic VL is a concern, considering the risk of transmission in highly endemic areas due to human-to-human transmission. The aim of this study was to report the sero-epidemiological prevalence in Bihar, India, a highly endemic area of VL, using the leishmanin skin test (LST) and the direct agglutination test (DAT). This was a cross-sectional study performed in Muzaffarpur, Bihar, India. Relatives of patients with VL were tested by LST and DAT. Other epidemiological data were evaluated and correlated with tests results. Forty individuals (either previous or current patients), and 109 household contacts were studied. There were 36% of male visceral leishmaniasis family members versus 17.57% of females visceral leishmaniasis family members, thus showing more males with symptomatic disease than females (p< 0.01). All visceral leishmaniasis cases had positive DAT tests, but only 37% of past cases were positive on the skin testing. Amongst healthy household contacts, 34% were DAT-positive, whilst 21% were LST-positive. The overall positivity for both assays combined was 44.8% and 23.8% were DAT-positive alone. The finding of high infection prevalence amongst asymptomatic individuals, and the estimation of those at greater risk for overt disease (DAT-positive alone) are important in the development of future disease control policies.


Assuntos
Leishmania/classificação , Leishmania/isolamento & purificação , Leishmaniose Visceral/diagnóstico , Testes Cutâneos/métodos , Teste de Coombs , Estudos Transversais , Feminino , Humanos , Índia , Leishmania/imunologia , Leishmaniose Visceral/imunologia , Masculino
6.
Vox Sang ; 115(5): 456-465, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32124460

RESUMO

BACKGROUND AND OBJECTIVES: It is sometimes difficult to obtain antigen-negative red blood cells (RBCs) for patients with antibodies against RBCs. However, the frequency and severity of the adverse reactions have not been well elucidated. Here, we conducted a multi-institutional collaborative study to clarify the background, frequency and clinical significance of antigen-positive RBC transfusions to patients with the respective antibodies. MATERIALS AND METHODS: The survey included the background of patients, antigens on RBCs transfused, total amount of antigen-positive RBCs transfused, results from antibody screen and direct antiglobulin tests, specificity of antibodies, adverse reactions and efficacies. All antibodies were surveyed regardless of their clinical significance. RESULTS: In all, 826 cases containing 878 antibodies were registered from 45 institutions. The main reasons for antigen-positive RBC transfusions included 'negative by indirect antiglobulin test' (39%) and 'detection of warm autoantibodies' (25%). In 23 cases (3% of total), some adverse reactions were observed after antigen-positive RBC transfusion, and 25 antibodies (9 of 119 clinically significant and 16 of 646 insignificant antibodies) were detected. Non-specific warm autoantibodies were detected in 9 cases, anti-E in 5 cases, 2 cases each of anti-Lea , anti-Jra or cold alloantibodies, and 1 case each of anti-Dib , anti-Leb or anti-P1. Other antibodies were detected in 2 further cases. Five (22%) of these 23 cases, who had anti-E (3 cases) or anti-Jra (2 cases), experienced clinically apparent haemolysis. CONCLUSIONS: Adverse reactions, especially haemolysis, were more frequently observed in cases with clinically significant antibodies than those with clinically insignificant antibodies (P < 0·001).


Assuntos
Antígenos de Grupos Sanguíneos/imunologia , Transfusão de Sangue , Hemólise , Isoanticorpos/sangue , Autoanticorpos/sangue , Autoanticorpos/imunologia , Teste de Coombs , Transfusão de Eritrócitos , Eritrócitos/imunologia , Feminino , Humanos , Isoanticorpos/imunologia , Japão , Masculino , Gravidez , Sensibilidade e Especificidade , Reação Transfusional
8.
Transfusion ; 60(4): 870-874, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32056233

RESUMO

BACKGROUND: The clinical and laboratory features of hemolytic disease of the newborn can be challenging to diagnose during pregnancy in the apparent absence of a blood group antibody. Low-frequency antibodies go undetected due to the lack of appropriate antigen-positive reagent red blood cells (RBCs). CASE REPORT: A pregnant woman of Southeast Asian descent was referred to a maternal-fetal medicine outpatient clinic due to a complicated obstetric history and a negative antibody screen. This initial visit at 29 weeks and 0 days' gestational age (GA) was unremarkable. A hydropic infant, born at 29 weeks and 5 days' GA, succumbed on the seventh day of life. Comprehensive laboratory testing was performed after birth. The hospital blood bank performed a maternal antibody identification. Direct antiglobulin test was performed on the cord blood. A reference laboratory confirmed an anti-Mia , performed paternal Mia phenotyping, and identified a hybrid glycophorin B-A-B GP*Mur allele. DISCUSSION: Maternal alloimmunization to low-frequency antigens remains a challenge. Southeast Asians make up a significant percentage in some US locations. Worldwide reports on the frequency of maternal alloimmunization of the MNS system can be used to guide the use of specific reagent RBCs for testing. Such strategies rely on the identification of blood donor units for reagent manufacture and use in perinatal antibody screens. CONCLUSION: The incidence of Mia and related antibodies is significant among Southeast Asians. In North America, prenatal antibody screening cells are not routinely chosen to match this population. The clinical and societal implications are discussed.


Assuntos
Eritroblastose Fetal/etiologia , Isoanticorpos/imunologia , Sistema do Grupo Sanguíneo MNSs/imunologia , Adulto , Americanos Asiáticos , Teste de Coombs , Eritroblastose Fetal/imunologia , Feminino , Feto/imunologia , Glicoforinas/imunologia , Humanos , Masculino , América do Norte , Gravidez
9.
Lab Med ; 51(2): 181-185, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31403670

RESUMO

OBJECTIVE: To test a hybrid polyethylene glycol (PEG)/gel method, specifically to attempt to increase reaction strength of accidentally overdiluted anti-Cob and broadly for proof of concept. METHODS: Methods were divided into 2 basic steps: sensitization and antiglobulin (AHG) testing. Sensitization was performed with PEG tubes, followed by AHG using the gel method. One wash was performed between the 2 steps. We tested 7 plasma antibody specimens. RESULTS: In addition to the first specimen, 6 additional antibodies were selected for detection by the PEG/gel hybrid method. Antibody reactivity was detected in all specimens tested with both methods. The PEG/gel method yielded enhanced reactivity in 3 of 7 antibodies (42.9%) and the equivalent of enhanced reactivity in 4 of 7 antibodies tested (57.1%). CONCLUSION: The reactivity of diluted anti-Cob (specimen 1) was increased; thus, our concept proved to be viable. The hybrid PEG/gel method showed the equivalent of enhanced or enhanced reactivity with all specimens tested and provided a stable medium.


Assuntos
Teste de Coombs/métodos , Géis , Polietilenoglicóis , Manejo de Espécimes/métodos , Humanos , Sensibilidade e Especificidade
10.
Lab Med ; 51(1): 50-55, 2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31150549

RESUMO

OBJECTIVE: To evaluate how clinical practice was affected by the change in direct antiglobulin testing (DAT) methodologies and subsequent stronger reported DAT results at our large academic medical center. METHOD: We retrospectively reviewed DAT results of umbilical cord blood from infants with blood type A or B born to mothers with antibody-negative type O blood, based on records kept at the University of Alabama at Birmingham (UAB) Hospital, a 1400-bed academic medical center. RESULTS: We randomly chose 50 neonates with positive DAT results who had been tested using the tube method and 50 whose testing had used the gel method. Although 86% of results with the tube method were positive microscopically, 52% and 40% of the DAT results with the gel method were 1+ and 2+ positive, respectively. Further, we observed an increase in the number of neonates treated with phototherapy who had been tested using the gel method. CONCLUSION: We report that DATs performed using the gel method had increased DAT strength compared with tube testing, which led to increased use of phototherapy by our clinical colleagues.


Assuntos
Teste de Coombs/normas , Hiperbilirrubinemia/sangue , Fototerapia/estatística & dados numéricos , Sistema ABO de Grupos Sanguíneos/imunologia , Centros Médicos Acadêmicos/estatística & dados numéricos , Automação Laboratorial/métodos , Automação Laboratorial/normas , Teste de Coombs/métodos , Feminino , Humanos , Hiperbilirrubinemia/diagnóstico , Hiperbilirrubinemia/terapia , Recém-Nascido , Masculino , Distribuição Aleatória
11.
Sci Rep ; 9(1): 19716, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31873137

RESUMO

Autoimmune haemolytic anaemia (AIHA) is a kind of autoimmune diseases characterized by autoantibodies which produced and secreted by abnormal activated B lymphocytes directed against red blood cells (RBC). Study reveals that about 50% AIHA mainly occurs secondary to lymphoproliferative disorders (LPD) and autoimmune diseases. In this study, we aim to explore the characteristics of patients with AIHA secondary to LPD. Fifteen patients with AIHA secondary to LPD (secondary group) and 60 with primary AIHA (primary group) were retrospectively included. Patients in the secondary group [(59.40 ± 4.74) y] were older than those in the primary group [(47.53 ± 2.30) y] (p = 0.024). Reticulocyte counts were lower for the secondary group [(134.55 ± 20.67) × 109/L] than for the primary group [(193.88 ± 27.32) × 109/L] (p = 0.09). Haptoglobin was higher in the secondary (0.75 ± 0.19) g/L than in the primary group (0.34 ± 0.05) g/L (p = 0.004). The ratio of CD3+CD4+/CD3+CD8+ was higher in the secondary (1.81 ± 0.41) than in the primary (1.05 ± 0.12) group (p = 0.025). Duration of remission was shorter in the secondary [(23.52 ± 5.20) months] than in the primary [(40.87 ± 3.92) months] group (p = 0.013). Relapse rate was higher for the secondary (33.3%) than for the primary (8.3%) group (p = 0.003). Mortality rate was higher in the secondary (33.3%) than in the primary (8.3%) group (p = 0.003). Progression-free survival was shorter in the secondary than in the primary group (p = 0.021). In conclusion, patients with AIHA secondary to LPD showed higher age at diagnosis, shorter remission time, and higher recurrence and mortality rates than did those with primary AIHA.


Assuntos
Anemia Hemolítica Autoimune/etiologia , Transtornos Linfoproliferativos/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Hemolítica Autoimune/imunologia , Teste de Coombs , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Intervalo Livre de Progressão , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
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
13.
Transfus Apher Sci ; 58(5): 659-662, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31542336

RESUMO

BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease presenting with variable and various clinical findings. PNH might be overlooked and diagnosis may be delayed due to low awareness about PNH. This is the first multicenter study in Turkey, investigating the efficiency of diagnostic screening of PNH by multiparameter flow cytometry (FCM) according to consensus guidelines. METHODS: We evaluate the efficiency of consensus clinical indications for PNH testing with FCM in 1689peripheral blood samples from 20 centers between January 2014 and December 2017. RESULTS: Overall, at the 20 centers contributing to this study, PNH clone were detected in 62/1689 samples (3.6%) by FCM test. 75.8% (n = 47) of patients with PNH clone had aplastic anemia, 3.2% (n = 2) had Coombs (-) hemolytic anemia, 6.5% (n = 4) had unexplained cytopenia, 3.2% (n = 2) had MDS with refractory anemia, 1.6% (n = 1) had hemoglobinuria and 9.7% (n = 6) had others (elevated LDH, splenomegaly, etc.). In contrast, we detect no PNH clone test in patients who were screened for unexplained thrombosis. CONCLUSIONS: Our study showed that current clinical indications for PNH testing are highly efficient and diagnostic screening of suspected patients for PNH with FCM is recommended. However, advanced screening algorithms are required for patients presenting with unexplained thrombosis and normal complete blood count.


Assuntos
Anemia Refratária , Teste de Coombs , Citometria de Fluxo , Hemoglobinúria Paroxística , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Refratária/sangue , Anemia Refratária/diagnóstico , Feminino , Hemoglobinúria Paroxística/sangue , Hemoglobinúria Paroxística/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Turquia
14.
Vet Clin Pathol ; 48 Suppl 1: 7-16, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31502273

RESUMO

BACKGROUND: A definitive diagnosis of immune-mediated hemolytic anemia (IMHA) can be difficult to make. However, it is critical to differentiate IMHA from other causes of anemia due to the impact on prognosis and outcome for IMHA patients. Recently published American College of Veterinary Internal Medicine recommendations for the diagnosis of IMHA should be followed to concurrently confirm ongoing anemia, verify in vivo hemolysis, and detect anti-erythrocyte antibodies. The reliability of immunologic IMHA tests varies depending on which test is used and how it is performed. OBJECTIVES: Our aims were to determine which tests are currently used in veterinary medicine to diagnose IMHA and review the utility of assays that have historically been used to diagnose IMHA. METHODS: A short survey was designed to see which diagnostic tests for IMHA were currently being used by veterinary practices. The survey was distributed via list-serves to veterinarians and veterinary technologists. A literature review was performed to report the utility of diagnostic tests for the diagnosis of IMHA. RESULTS: Survey respondents indicated a variability in test protocols used to diagnose IMHA. Most respondents perform saline agglutination or Coombs' tests to detect anti-erythrocyte antibodies. Additional tests that can be used to support a diagnosis of IMHA are discussed in this review. CONCLUSIONS: A standardized diagnostic approach should be followed to differentiate IMHA from other causes of anemia. Test methodology can vary from one laboratory to another, and clinicians should be familiar with the procedures used by their laboratory.


Assuntos
Anemia Hemolítica Autoimune/veterinária , Doenças do Cão/diagnóstico , Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/patologia , Animais , Teste de Coombs/veterinária , Testes Diagnósticos de Rotina , Doenças do Cão/patologia , Cães , Eritrócitos/patologia , Prognóstico , Inquéritos e Questionários
15.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466966

RESUMO

We reported a case of a woman with no past medical illness who presented with a few days' history of fever, myalgia, arthralgia, hypochromic microcytic anaemia and thrombocytopaenia and who was nonstructural protein 1 antigen (NS1Ag)-positive. Haemolytic anaemia including full blood picture work-up revealed high reticulocyte count and haemolysis with positive direct Coombs test. She was started on prednisolone and was discharged well.


Assuntos
Anemia Hemolítica/etiologia , Dengue/complicações , Dengue/tratamento farmacológico , Adulto , Teste de Coombs/métodos , Dengue/sangue , Dengue/imunologia , Diagnóstico Diferencial , Feminino , Febre/diagnóstico , Hemólise , Humanos , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Contagem de Reticulócitos , Trombocitopenia/diagnóstico , Trombocitopenia/etiologia , Resultado do Tratamento
16.
Arch Iran Med ; 22(6): 336-339, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31356100

RESUMO

Evans syndrome is a rare syndrome associated with the simultaneous or sequential development of autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP). Furthermore, acute kidney injury (AKI) is a syndrome characterized by the rapid loss of kidney excretory function and is most often secondary to extrarenal events. However, AKI has rarely been recorded in Evans syndrome without systemic autoimmune disease and malignant tumors of the blood and lymphatic system. Herein, we report the case of a patient who exhibited Evans syndrome presenting with AKI. A 73-year-old woman presented with diarrhea, anuria, low platelet count, and developed a progressive increase of blood urea nitrogen and serum creatinine, as well as anemia with a positive direct Coombs test. We excluded hemolytic uremic syndrome, ITP, and leukemia. Treatment with antibiotics, rehydration therapy, and hemodialysis resulted in partial remission; thus, we diagnosed the patient with Evans syndrome presenting with AKI. The patient was successfully treated by the addition of steroid treatment. When AKI presents with hemolysis and thrombocytopenia, physicians should consider Evans syndrome, which can be appropriately treated when detected early.


Assuntos
Lesão Renal Aguda/etiologia , Anemia Hemolítica Autoimune/diagnóstico , Trombocitopenia/diagnóstico , Lesão Renal Aguda/terapia , Idoso , Anemia Hemolítica Autoimune/complicações , Antibacterianos/uso terapêutico , Teste de Coombs , Feminino , Humanos , Diálise Renal , Esteroides/uso terapêutico , Trombocitopenia/complicações
18.
BMJ Case Rep ; 12(7)2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31331930

RESUMO

Haemolytic disease of the fetus and newborn (HDFN) is associated with red cell antibodies. Anti-M usually results in a mild haemolysis and is rarely clinically significant. There is no established consensus on management of pregnancies with anti-M. A case of recurrent HDFN with maternal M alloimmunisation was identified at a tertiary hospital in Australia. We collected the patient and neonate's clinical and pathological data and interpreted the case with available literature. This is the first case in literature of recurrent fetal hydrops in the setting of M alloimmunisation. Neonate was delivered in a poor condition, intubated and admitted to the neonatal intensive care unit for ionotropic support, red cell transfusion and plasma transfusion for coagulopathy. Direct Coombs test was positive, confirming HDFN. Although anti-M rarely causes HDFN, accurate history, fetal surveillance and monitoring is essential for identification of fetal anaemia. Concurrent placental disease may increase fetal risk from anti-M antibodies.


Assuntos
Incompatibilidade de Grupos Sanguíneos/complicações , Eritroblastose Fetal/etiologia , Hidropisia Fetal/etiologia , Sistema do Grupo Sanguíneo MNSs , Adulto , Ascite/diagnóstico por imagem , Cardiotocografia , Teste de Coombs , Eritroblastose Fetal/sangue , Feminino , Humanos , Hidropisia Fetal/sangue , Hidropisia Fetal/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Gravidez , Recidiva
19.
Blood Cells Mol Dis ; 79: 102342, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31302454

RESUMO

In beta-thalassemia patients, erythrocyte autoantibodies can remain silent or lead to Autoimmune Hemolytic Anemia (AIHA).The aim of this study was to identify predictors of AIHA in beta-thalassemia patients with positive Direct Antiglobulin Test (DAT), in Tunisia. This longitudinal prognosis study was carried out on beta-thalassemia patients with a positive confirmed DAT. Predictors of AIHA were identified the Kaplan-Meier method. A Cox model analysis was used to identify independent predictors. Among 385 beta thalassemia patients, 87 developed positive DAT (22.6%). Autoimmune hemolytic anemia was occurred in 25 patients. Multivariate analysis showed that AIHA was independently associated with beta-thalassemia intermedia and similar family history of AIHA. Splenectomy in patients with positive DAT was independently associated with an increased risk of AIHA (HR = 6.175, CI: 2.049-18.612, p < 0.001). The risk of developing AIHA was higher during the first 72 transfusions. Autoimmune hemolytic anemia was significantly associated with polyspecific DAT (anti-complement and anti-IgG), blood group AB and prior alloimmunization. Whereas transfusion by phenotypic and leukoreduced blood was a protective factor. In summary, splenectomy after autoimmunization, prior alloimmunization, DAT specificity (IgG with complement), thalassemia intermedia, AB blood group and family history of AIHA were strongly associated with AIHA. Leukoreduced blood transfusion had a proven preventive role.


Assuntos
Anemia Hemolítica Autoimune/etiologia , Autoanticorpos/sangue , Eritrócitos/imunologia , Talassemia beta/complicações , Sistema ABO de Grupos Sanguíneos , Adulto , Transfusão de Sangue/métodos , Teste de Coombs , Feminino , Humanos , Procedimentos de Redução de Leucócitos , Estudos Longitudinais , Masculino , Anamnese , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Esplenectomia , Tunísia , Talassemia beta/cirurgia , Talassemia beta/terapia
20.
Transfus Clin Biol ; 26(4): 240-248, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31279519

RESUMO

Red blood cell alloimmunization is one of the major challenges to regular transfusions in ß-thalassemic patients. In Morocco, rare studies have focused on this hemoglobinopathy. OBJECTIVE: We aimed to study the prevalence and risk factors of red cell alloimmunization in ß-thalassemic patients. PATIENTS AND METHODS: Retrospective study during 9 years (2009-2018) was conducted on 160 ß-thalassemic patients transfused regularly in pediatric department of children's hospital in Casablanca, Morocco. The main clinical, demographic and transfusional characteristics of alloimmunized and non-alloimmunized patients were compared. Red blood cells units transfused were leukodeplated and phenotypically matched for RH-KELL systems and for other systems after immunization. Screening and antibody identification were performed by gel-filtration method on BIO-RAD caseds using 3 and 11 red blood cells panels. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG/C3d) gel cards. RESULTS: The prevalence of alloimmunizations was 8.75% during the study period. Seventeen alloantibodies identified were directed mainly against antigens of KELL and RH systems: KEL 1 (35.29%), RH 3 (23.52%), RH1 (11.76%), Kpa (11.76%), RH2 (5.88%). Red blood cells autoantibodies had been detected in 6 of 14 (42.85%) of alloimmunized patients versus 12 of 146 (11.76%) of non-alloimmunized patients (P<0.01). Presence of autoantibodies, transfusional interval<3weeks and gender were associated with high rate of red cells alloimmunization. CONCLUSION: This study proves the data of literature. The presence of red cell autoantibodies appears to be a major risk factors for alloimmunization in thalassemic children, and could advocate specific transfusion guidelines.


Assuntos
Autoanticorpos/imunologia , Transfusão de Eritrócitos , Eritrócitos/imunologia , Isoanticorpos/imunologia , Talassemia beta/imunologia , Adolescente , Adulto , Fatores Etários , Especificidade de Anticorpos , Autoanticorpos/sangue , Incompatibilidade de Grupos Sanguíneos , Tipagem e Reações Cruzadas Sanguíneas , Criança , Pré-Escolar , Teste de Coombs , Humanos , Lactente , Isoanticorpos/sangue , Marrocos/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem , Talassemia beta/terapia
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