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HemaSphere ; 6:2679-2681, 2022.
Article in English | EMBASE | ID: covidwho-2032097


Background: Autoimmune haemolytic anaemia (AIHA) during pregnancy is a rare finding, and few is known about maternal and foetal outcomes. AIHA may either develop or relapse during gestation and postpartum or be an issue in a patient on active therapy who becomes pregnant. AIHA management during pregnancy and lactation is not standardized and drug use is often limited by safety concerns. Aims: We studied AIHA impact on pregnancy focusing on disease severity, treatment need and maternal/foetal outcome. Methods: Through a multicentric retrospective cohort study, we identified 38 pregnancies occurred in 28 women from 1997 to 2021 in 10 European centres in Italy, Denmark, France, the Netherlands, USA, and Spain. All included patients had a previous AIHA history or developed/exacerbated AIHA during gestation or postpartum. AIHA was classified according to the direct antiglobulin test. Results: We registered 18 warm AIHA (10 IgG;8 IgG+C3d), 2 cold agglutinin disease, 3 mixed and 5 atypical forms (Table 1). Evans syndrome (i.e., association of AIHA and immune thrombocytopenia or neutropenia) was present in 4. Mean age at AIHA diagnosis was 27 (3-39) and at pregnancy 32 (21-41) years. AIHA diagnosis predated pregnancy in 15 women and had required at least 1 therapy line in all of them, and >2 lines in 12 (rituximab, N=7;cytotoxic immunosuppressants, N=6;splenectomy, N=5). Among these 15 patients, 6 had a relapse during pregnancy, 3 during postpartum and 9 were on active treatment at the time of pregnancy (steroids, N=8;cyclosporine, N=1;azathioprine, N=1;the latter stopped after positive pregnancy test). A patient with a previous AIHA, relapsed as immune thrombocytopenic purpura during pregnancy. Further 8 patients had an AIHA onset during gestation and 2 postpartum. A patient had AIHA onset during the postpartum of the 1st pregnancy and relapsed during the 2nd one. In the 20 women experiencing AIHA during pregnancy/postpartum, median Hb and LDH levels were 6,4 g/dL (3,1 - 8,7) and 588 UI/L (269-1631), respectively. Management consisted in blood transfusions (N=10) and prompt establishment of steroid therapy+/-IVIG (N=20), all with response (complete N=13, partial N=7). After delivery, rituximab was necessary in 4 patients and cyclosporine was added in one. Anti-thrombotic prophylaxis was given in 7 patients. Overall, we registered 10 obstetric complications (10/38, 26%), including 4 early miscarriages, a premature rupture of membranes, a placental detachment, 2 preeclampsia, a postpartum infection and a biliary colic. Apart from the case of biliary colic and one of the two cases of preeclampsia, 8/10 complications occurred during active haemolysis and treatment for AIHA. Nine foetal adverse events (9/38, 24%) were reported: a transitory respiratory distress of the new-born in a mother with active AIHA, 3 cases of foetal growth restriction, a preterm birth, an infant reporting neurologic sequelae, a case of AIHA of the new-born requiring intravenous immunoglobulins, blood transfusions and plasma exchange, and 2 perinatal deaths. The latter both occurred in women on active AIHA therapy and were secondary to a massive placental detachment and a symptomatic SARS-CoV-2 infection. (Figure Presented ) Summary/Conclusion: AIHA developing/reactivating during pregnancy or postpartum is rare (about 5%) but mainly severe requiring steroid therapy and transfusions. Importantly, severe maternal and foetal complications may occur in up to 26% of cases mostly associated with active disease, pinpointing the importance of maintaining a high level of awareness. Passive maternal autoantibodies transfer to the foetus seems a rare event.

Respirology ; 27(SUPPL 1):40, 2022.
Article in English | EMBASE | ID: covidwho-1816634


Introduction/Aim: While effective and recommended, concerns remain over the widespread, long-term use of macrolide antibiotics in obstructive airway diseases (OADs), particularly relating to antimicrobial resistance. The main objective of this study is to evaluate the effect of deescalation of maintenance macrolide antibiotics during the Australian summer season on exacerbations of OADs. Methods: A double-blind, placebo-controlled, non-inferiority, randomized-controlled trial designed using telehealth. All assessments are conducted over the phone, and the allocated study medication is mailed to participants. We plan to recruit 160 adult participants who are on maintenance macrolide therapy for at least 6 months for the management of asthma, COPD or bronchiectasis. Participants will be randomized to two arms at the start of summer, arm-1 participants will switch from their current macrolide to azithromycin 500 mg for 9 months while arm-2 participants will switch to an identical placebo for the same duration. Telephone follow-up interviews will be conducted at 3-, 6- and 9-months with two additional safety check-in calls during the initial 3 months. The primary outcome is exacerbation. Results: The recruitment and follow-ups are ongoing, without interruption by the COVID-19 lockdowns. We have recruited 39 patients (mean age ± SD 70.0 ± 9.32;54% male) in 2020, and 28 (72%) successfully completed the 9-month treatment with allocated study medication. Of the remaining, 10 were discontinued due to worsening symptoms/exacerbations, and one due to a serious adverse event (SAE). The retention rate at 9-month is currently at 97%. A total of seven unrelated SAEs have been reported so far (all resolved). Conclusion: This novel study will allow us to determine the effect of treatment breaks during periods of lower exacerbation risk. The telehealth-based study design is COVID-19 appropriate and provided greater flexibility for participants to attend interviews, improving the recruitment and retention rate.

Respirology ; 27:109-109, 2022.
Article in English | Web of Science | ID: covidwho-1762654