A 3-Case Series of Autoimmune Haemolytic Anaemia and COVID-19: Is Plasma Exchange an Alternative?

COVID-19 has rarely been associated with immune-mediated phenomena such as autoimmune haemolytic anaemia (AIHA). Both cold hemolysis with cold agglutinin detection and warm haemolysis have been described with variable prognoses. Current treatment regimens are based on experience with other case series and case reports, which still represent a clinical challenge. Corticosteroids, red cell transfusions and rituximab have been successfully employed. We present 3 cases of AIHA in the context of COVID-19 disease, the first case successfully treated with plasma exchange and long-term follow-up of the 3 cases showing complete remission of anaemia.

Diagnostic value of CT, PET and combined PET/CT performed with low-dose unenhanced CT and full-dose enhanced CT in the initial staging of lymphoma.

AIM: The aim of this paper was to compare the accuracy of contrast-enhanced computed tomography (CT), positron emission tomography (PET), unenhanced low-dose PET/CT (LD-PET/CT) and full-dose enhanced PET/CT (FD-PET/CT) for the initial staging of lymphoma. METHODS: One hundred and one lymphoma patients were examined by [18F]FDG-PET/CT including unenhanced low-dose CT and enhanced full-dose CT. Each modality of PET/CT was evaluated by a nuclear medicine physician and a radiologist unaware of the other modality, while the CT and PET images were interpreted separately by another independent radiologist and nuclear medicine physician respectively. The nodal and extranodal lesions detected by each technique were compared with a reference standard. RESULTS: For nodal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative LR (LR-) of LD-PET/CT were 97%, 96%, 98%, 95%, 26 and 0.02 respectively, and those of FD-PET/CT were 97%, 97%, 98%, 95%, 36 and 0.02. These results were significantly better than those of PET (sensitivity 82%, specificity 81%, PPV 88%, NPV 72%, LR+ 4.3, LR- 0.21). Likewise, both PET/CT displayed a higher sensitivity, NPV and LR- than CT (91%, 84%, 0.1 respectively). For organ evaluation, both modalities of PET/CT also had significantly better sensitivity and NPV than that of PET (LD-PET/CT: sensitivity 92%, NPV 90%; FD-PET/CT sensitivity 94%, NPV 92%; PET: sensitivity 70%, NPV 69%). The sensitivity, specificity, PPV and NPV for bone marrow involvement were 29%, 84%, 45% and 72% respectively for PET, and 29%, 90%, 56%, and 74% for both, LD-PET/CT, and FD-PET/CT. No significant differences were found between LD-PET/CT and FD-PET/CT, but FD-PET/CT detected important incidental findings in 5.9% of patients. CONCLUSION: PET/CT is an accurate technique for the initial staging of lymphomas without significant differences between LD-PET/CT and FD-PET/CT. FD-PET/CT detects relevant incidental findings that are missed on LD-PET/CT.

Autologous peripheral blood stem cell transplant in patients previously diagnosed with invasive aspergillosis.

Patients previously diagnosed with invasive aspergillosis (IA) have been considered to be at risk for relapse of mycosis during subsequent hematopoietic transplant. Even with prophylactic measures, reactivation of the infection occurs in 29% of patients undergoing bone marrow transplantation (BMT). A period of neutropenia is one of the variables considered to be a risk factor for reactivation. Peripheral blood stem cell transplant (PBSCT) results in a shorter neutropenia period leading to a lower risk of fungal infection. A retrospective data analysis performed on patients undergoing autologous PBSCT for hematological malignancies in our unit showed that nine patients were diagnosed before transplantation with IA. All patients received only medical treatment during their primary infection. Medical prophylaxis was administered in seven of these patients, and two underwent transplantation without prophylaxis. All patients developed severe neutropenia after a myeloablative regimen. All but one had neutropenic fever, although the fever was controlled and no fungal complications occurred. All patients in this series achieved complete hematological engraftment without delay in granulocyte recovery (mean: 8.78 vs 9.76; p=0.58). No significant differences were observed in toxicities with regards to transplantation between patients previously diagnosed with IA and their controls. Recurrence of IA related to transplantation was avoided since no relapse of IA was demonstrated. This series of nine patients with a previous history of IA shows that medical treatment, secondary prophylaxis, and peripheral blood as a source of stem cells could be effective measures to avoid reactivation of previous aspergillosis during hematopoietic transplantation, although prospective randomized trials should still be performed to confirm these findings in a wider setting.

Secondary acute myeloid leukemia and myelodysplasia after autologous peripheral blood progenitor cell transplantation.

Secondary myelodysplastic syndrome (MDS) and acute leukemia (AL) are well-known complications of antineoplastic therapy. The incidence of these serious complications after autologous hematopoietic transplantation ranges from 1.1% to 24%. Prior chemotherapy is its most likely cause, but other variables related to these long-term complications are seriously discussed. There is evidence that priming of progenitor cells isolated from peripheral blood with chemotherapy is also related to a higher risk of secondary MDS/AL. Whether progenitor cells isolated from bone marrow or peripheral blood after mobilization only with cytokines are related to higher risk is a controversial issue. In this paper, we analyze the incidence and variables related to these complications in a series of 99 patients diagnosed with lymphoma or multiple myeloma who underwent autologous transplantation using hematopoietic progenitors isolated from peripheral blood mobilized with granulocyte colony-stimulating factor (G-CSF). The probability of MDS/AL in patients alive 5 years after transplant in our series is 8.58%, similar to that reported in other series using bone marrow grafts. The total dose of cyclophosphamide ( p=0.099), the number of chemotherapy cycles ( p=0.04) received before transplant, and the total dose of mononuclear cells infused at the time of transplant were the only variables associated with secondary MDS/AL. Autologous transplantation with progenitor cells isolated from peripheral blood after mobilization with cytokines has probability and risk factors for secondary MDS/AL development similar to bone marrow grafts when compared with other published series.

[Evaluation of the polyethyleneglycol antiglobulin test in the detection and identification of erythrocyte antibodies]. / Valoración de la prueba de antiglobulina con polietilenglicol en la detección e identificación de anticuerpos eritrocitarios.

PURPOSE: The polyethylene glycol antiglobulin test has been found to enhance the reactivity of most alloantibodies. MATERIAL AND METHODS: To investigate the utility of polyethylene glycol antiglobulin test for detection and identification of red blood cell antibodies, a comparison study of polyethylene glycol (PEG), a low-ionic-strength additive solution (LISS) and bovine serum albumin (BSA) was conducted. The sera of 47 different patients with positive antibody screening test by the LISS method, were tested in parallel with reagent antibody-detection cells using PEG, LISS and BSA. RESULTS: In the sera of 47 patients, 57 antibodies were detected. We identified 39 antibodies by the three methods. Twelve antibodies reacted by the BSA method and the LISS method but did not react with the PEG method (8 anti-I, 1 anti-P1, 1 anti-Lea(a), and two antibodies missed by the PEG method because they did not react with anti-IgG: 1 anti-M and 1 anti-K). Three antibodies reacted only with the LISS method (3 anti-I). Four clinically significant antibodies were detected only by the PEG method (2 anti-Jka, 1 anti-Jkb, 1 anti-c). The serum from a patient with delayed hemolytic transfusion reaction and no antibody detectable by the LISS and the BSA methods was tested by the PEG method. We were able to detect an anti-Jka by PEG in the pretransfusion sample. In 24 (60%) of 40 samples with clinically significant antibodies, PEG antiglobulin reactions were stronger (total score 221) than LISS antiglobulin reactions (total score 170) and BSA antiglobulin reaction (total score 184); in 14 (35%) of 40 samples, they were identical, and in 2 (5%) agglutination in the PEG method was weaker. CONCLUSION: In our experience, the polyethylene glycol antiglobulin test is more sensitive than LISS and BSA in detecting clinically significant antibodies and is an acceptable technique for routine compatibility test.