ABSTRACT
Drug-induced immune hemolytic anemia (DIIHA) is a rare cytopenia caused by damage to RBCs by drug-induced antibodies or non-immune protein adsorption (NIPA). The drugs associated with DIIHA and the mechanistic hypotheses that are thought to be involved have been controversial, with complex serological tests often required by specialized Immune Hematology laboratories for diagnosis. It is necessary to know the clinical manifestation and laboratory diagnosis of DIIHA in order to distinguish the immuno-hematological abnormality caused by drugs from other causes. How to improve the diagnostic ability of DIIHA and establish a scientific and reasonable idea of DIIHA serological examination is urgent to help clinical diagnosis and correct treatment.
ABSTRACT
Resumen El síndrome del linfocito pasajero (PLS) es una complicación de injerto contra huésped que se presenta en el trasplante de órganos sólidos o en el trasplante de células progenitoras hematopoyéticas. Es una causa importante de hemólisis inmune después del trasplante causada por la producción de anticuerpos por parte de los clones específicos de linfocitos B viables transferidos a través del órgano del donante contra los antígenos de los glóbulos rojos del receptor. Generalmente ocurre en los trasplantes con discordancia menor ABO o Rh. Este estudio descriptivo describe el caso de un paciente de 54 años con grupo sanguíneo O/Rh(D) positivo, con cirrosis secundaria a enfermedad metabólica asociada al hígado graso (MAFLD) que fue llevado a trasplante hepático de donante O/Rh(D) negativo. A los 9 días del trasplante presentó una anemia hemolítica inmune por anticuerpos anti-D por efecto del linfocito B pasajero del donante sensibilizado. El paciente recibió medidas de soporte, transfusión de glóbulos rojos e inmunosupresión con esteroides, con lo que se logró la estabilización de los parámetros hemolíticos. En conclusión, esta es una entidad que se debe sospechar en caso de anemia hemolítica aguda en el período postrasplante.
Abstract Passenger lymphocyte syndrome (PLS) is a graft-versus-host complication in solid organ transplantation or hematopoietic stem cell transplantation. It is a major cause of immune hemolysis after transplantation caused by the production of antibodies by the specific clones of viable B lymphocytes transferred through the donor organ against the antigens of the recipient's red blood cells. It usually occurs in transplants with minor ABO or Rh mismatch. This descriptive study explains the case of a 54-year-old patient with O/Rh(D) positive blood group, with cirrhosis secondary to metabolic disease associated with fatty liver (NAFLD), who underwent liver transplantation from an O/Rh(D) negative donor. Nine days after the transplant, the patient presented with immune hemolytic anemia due to anti-D antibodies because of the transient B lymphocyte from the sensitized donor. The patient received support measures, transfusion of red blood cells, and immunosuppression with steroids, which stabilized the hemolytic parameters. In conclusion, this entity should be suspected in the case of acute hemolytic anemia in the post-transplant period.
ABSTRACT
【Objective】 To compare the efficacy and safety of transfusion of suspended RBCs and washed RBCs in patients with positive direct Coombs testing results. 【Methods】 A retrospective analysis was conducted on 98 patients with positive direct Coombs testing results as 2+ or less in the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2020. Among them, 31 patients, from January 2015 to December 2016, were transfused with washed RBCs and set as the control group; the other 67 patients, from January 2017 to December 2020, transfused with suspended RBCs, were enrolled as the experimental group. The changes of main laboratory indexes and the incidence of transfusion adverse reactions before and after transfusion of 2 U and 4 U RBCs were compared between the two groups to evaluate the efficacy and safety of transfusion. 【Results】 After 2 U and 4 U transfusion, Hb increased by 12±4.967 (g/L) and 23.78±12.736 (g/L) in the control group, while 12.85±7.109 (g/L) and 22.68±9.832 (g/L) in the experimental group, All transfusions of the two groups were effective, and no significant differences in Hb, TBIL, IBIL and LDH were noticed by groups (P>0.05). No significant difference in the incidence of adverse reactions to blood transfusion between the 2 groups was observed (P>0.05). 【Conclusion】 The transfusion of suspended RBCs is safe and effective in patients with positive direct Coombs testing results as 2+ or less, and the transfusion of washed RBCs was unnecessary.
ABSTRACT
Childhood pneumonia has a myriad of disease causing organisms. Identifying the etiology often helps us predict the natural course of the illness. We would like to share an interesting child with pneumonia by the hematological manifestation of the disease. Case report of this study is a 8 year old boy who presented with high grade fever for eleven days associated with cough. History of skin rashes which worsened following therapy with penicillin. On Examination child had maculopapular rashes predominantly over the trunk with decreased air entry in the left hemithorax. Chest x-ray done showed left lower lobe consolidation hence treated with cephalosporins and macrolide. Counts revealed falling trend in haemoglobin with high MCV count. Peripheral smear done showed agglutinated RBC'S and occasional nucleated RBC's. Direct Coombs test was positive. With these haematological manifestations child was diagnosed to have Mycoplasma pneumonia which was proven by positive antibodies against Mycoplasma. Child recovered completely and haematological manifestations became passive after four weeks. Cold agglutinin disease is poorly understood affecting 15% of patients with Autoimmune hemolytic anemia. Respiratory tract involvement and extrapulmonary complications manifest in 3-10% and 25% respectively. Antibodies (IgM) against the I antigen on human erythrocyte membranes appear during the course of M. pneumoniae infection and produce a cold agglutinin response. AIHA typically occurs during 2-3rd week after febrile illness with sudden onset of hemolysis which is self-remitting within 4-6 weeks. The conclusion of this study is extra-pulmonary manifestations in a child with pneumonia help in diagnosing the etiology. This in turn helps us like provide rationale management and Predict the natural course of the illness.