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Objective:To explore the effect of Vancomycin on immune hemolysis and coagulation in children with non-Hodgkin′s lymphoma (NHL), thus providing the basis for the diagnosis and treatment of hemolytic anemia and coagulation dysfunction caused by Vancomycin, and guiding the rational use of drugs in children with NHL.Methods:From January 2018 to January 2019, 31 children with NHL treated with monotherapy of Vancomycin in Beijing Children′s Hospital, Capital Medical University were collected.Plasma samples within 1 week of Vancomycin medication were collected for detecting the anti-Vancomycin antibody by microcolumn gel method.The laboratory diagnostic and coagulation function indexes of hemolytic anemia before and after Vancomycin medication were analyzed using the paired sample t test. Results:Fourteen out of 31 children with NHL were positive for the anti-Vancomycin antibody, and among them, 10 cases had positive direct antiglobulin test (DAT). In NHL children with positive anti-Vancomycin antibody, their red blood cell count (RBC)[(2.75±0.07)×10 12/L vs.(3.18±0.07)×10 12/L], platelet count (PLT)[64.29±14.87)×10 9/L vs.(91.36±16.84)×10 9/L] and hematocrit (HCT)[(23.02±0.83)% vs.(29.19±1.98)%] were significantly reduced after Vancomycin medication than those before treatment (all P<0.01). On the contrary, total bilirubin (TB) [(51.96±15.52) μmol/L vs.(39.34±13.40) μmol/L], direct bilirubin (DB)[(31.30±13.98) μmol/L vs.(26.38±12.61) μmol/L], indirect bilirubin (IB)[(21.81±2.89) μmol/L vs.(13.75±1.63) μmol/L] and lactate dehydrogenase (LDH)[(208.6±16.85) U/L vs.(60.93±16.00) U/L] in them were significantly enhanced after Vancomycin medication than those before treatment (all P<0.05). Prothrombin time (PT)[(13.94±0.58) s vs.(11.66±0.30) s] and partial thromboplastin time (APTT)[(36.01±2.64) s vs.(28.09±0.98) s] were significantly prolonged in them after vancomycin medication than those before treatment (all P<0.01). A higher international normalized ratio (INR)(1.25±0.05 vs.1.05±0.02) was detected in NHL children with positive anti-Vancomycin antibody after medication ( P<0.000 1). In NHL children with negative anti-Vancomycin antibody, significantly higher PT (12.99±0.35) s vs.(11.82±0.27) s and INR (1.18±0.03 vs.1.07±0.03) were detected after Vancomycin medication (all P<0.000 1), while other indexes were similar before and after treatment. Conclusions:The anti-Vancomycin antibody may cause immune hemolysis and coagulation dysfunction in children with NHL.In order to prevent serious adverse events caused by drug antibodies, comprehensively clinical symptoms should be considered, drug antibodies and laboratory test results should be detected.
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BACKGROUND: Immune hemolysis secondary to ABO minor incompatibility is a rare graft versus host disease in renal recipients, secondary to anti-ABO antibody produced by lymphocytes of donor origin that reacts against recipient RBCs. METHODS: To investigate the incidence and clinical features of immune hemolysis secondary to ABO minor incompatibility in renal allograft recipients, clinical records of 358 renal transplantation performed in Maryknoll Hospital since 1991 were analyzed retrospectively. RESULTS: Fifty four (15%) of 358 renal transplants were ABO minor incompatible. Immune hemolysis secondary to anti-ABO antibody developed in 5 (9.2%) of 54 ABO minor incompatible renal transplant recipients. Immune hemolysis occurred in 3 (13.6%) patients among 22 allografts from blood type O donor to A recipients and 2 (10%) patients among 20 from blood type O donor to B recipients. All 5 patients received cyclosporin with prednisolone, and MMF was administered to one patient additionally. Immune hemolysis developed on 14+/-3 days after renal transplantation and lasted for about 10+/-3 days. The maximum reduction of hemoglobin was 3.3+/-1.0 g/dL. All patients required donor type (blood type O) washed RBCs transfusion (5.0+/-2.6 units per patient) and plasmapheresis were performed in 3 patients (4.0+/-1.0 per patient). All patients recovered without deterioration of graft function. Age, number of HLA mismatch, creatinine at 1 year after transplantation, frequency of acute rejection and serum cyclosporin level during first 2 weeks were not significantly different between hemolysis group (N=5) and non-hemolysis group (N=49). Living unrelated transplantation is associated with increased incidence of immune hemolysis compared with living related transplantation (p<0.01). CONCLUSION: Although immune hemolysis secondary to ABO minor incompatibility is uncommon, we experienced cases with marked reduction of hemoglobin that required a large amount of transfusion. Therefore, this type of immune hemolysis needs to be considered as a differential diagnosis of posttransplant hemolysis. As our center routinely performs donor specific transfusion (DST), the incidence may be higher than that of other centers where DST is not usually given.