[Diagnostic performance of κ/λ serum free light chain ratio (Freelite® assay) and IgGκ/IgGλ ratio (Hevylite® assay) as prognostic biomarkers of the evolution of immune thrombocytopenia into a chronic disease in adult patients]. / Performance diagnostique des rapports κ/λ des chaines légères libres sériques (test Freelite®) et IgGκ/IgGλ (test Hevylite®) comme marqueurs pronostiques de chronicisation du purpura thrombopénique immunologique de l'adulte.

INTRODUCTION: Immune thrombocytopenia (ITP) is an acquired hemorrhagic disease due to antiplatelet antibodies, that will become a chronic disease in 70% of adults. Most of chronic ITP patients display clonal restriction of antiplatelet antibodies. To date, there is no biomarker able to predict the evolution of the disease. The objective of the study is to determine whether Hevylite® and/or Freelite® assays are prognostic factors for progression to chronic ITP. METHODS: This is a retrospective, monocentric, prognostic study of a biomarker, performed using frozen samples stored in a serum library. Freelite® and a Hevylite® assays were performed on the samples collected at diagnosis for adult patients with newly diagnosed ITP at the University Hospital of Poitiers between 2014/01/01 and 2017/05/01. To predict the evolution into a chronic disease, a ROC curve analysis was performed on four variables: IgGκ, IgGκ/IgGλ ratio, IgGκ - IgGλ, and κ/λ ratio. RESULTS: Thirty-two patients were included and analyzed. No patient had an abnormal κ/λ ratio. Three patients had an abnormal IgGκ/IgGλ ratio. The following variables IgGκ, IgGκ/IgGλ, IgGκ - IgGλ, and κ/λ ratio were not able to predict progression to chronic ITP in our study. CONCLUSION: This study did not reveal any prognostic value of the Freelite® and Hevylite® tests on the evolution of ITP into a chronic disease.

[Diagnosis and management of acquired immune haemolytic anaemia excluding neoplasia. Adequacy with the current guidelines published in 2009]. / Diagnostic et prise en charge de l'anémie hémolytique auto-immune à l'exclusion des formes secondaires à une cause néoplasique. Adéquation de la prise en charge au PNDS octobre 2009.

OBJECTIVES: Describe the management of Acquired Immune Haemolytic Anaemia (AIHA) and correlate with the current guidelines published in 2009. The secondary objective was to calculate the positive predictive value of the Direct Antiglobulin Test (DAT) for the diagnosis of AIHA. METHODS: A retrospective and monocentric study was performed from 2010 to 2015 based on positive DATs, identified in the French Blood Agency database or in medical files. All patients managed for initial diagnosis or relapse of AIHA were included, excluding neoplasia. RESULTS: Six hundred and twenty-three patients had a positive DAT, 42 had non-neoplastic AIHA. Thirty-nine patients were included, 32 had warm antibodies, 5 had a negative DAT and 2 had cold antibodies. No cause was found for 46% (17/37) of the warm antibody and negative DATs AIHAs. Autoimmune disease was found in 11 cases (30%), infection in 4 cases (11%). The etiologic investigations were consistent with the guidelines in 49% of cases. Corticosteroids were first prescribed, as recommended. Second-line treatments were rituximab in 9 cases, splenectomy in 4 cases and azathioprine in 3 cases. The management of cold antibody AIHA complied with the guidelines. The positive predictive value of DATs in hospitalized population was of 14% (85/610). CONCLUSION: AIHA guidelines seem insufficiently applied in our center.

[Infectious events during the course of autoimmune diseases treated with rituximab: A retrospective study of 93 cases]. / Événements infectieux survenus au cours des maladies auto-immunes traitées par rituximab : à partir d'une étude rétrospective de 93 cas.

OBJECTIVE: Describe the occurring infections in patients treated with rituximab for an autoimmune disease. METHODS: Retrospective and monocentric study of 93 adult patients treated with rituximab for autoimmune indications over a nine years period. RESULTS: Thirty-eight patients suffered from a total of 95 infections. Out of them, 18 patients (19 %) had had at least an infectious episode triggering a hospital admission and/or intravenous treatment. The infections occurred mainly during the first year of the treatment (65 %) and if the courses are repeated (P=0.04). They were mainly pulmonary infections. Severe infections, recorded in 79 % of the cases, were mostly of bacterial origin (43 %) and viral (23 %). Two cases of pneumocystis pneumonia and one case of invasive pulmonary aspergillosis were also recorded. The notion of vaccination was present in less than half of the cases, and 39 % of the patients were already receiving a prophylactic treatment against pneumocystis pneumonia. Patients over the age of 65 years (40 %) had developed less infections (P<0.05). Eight of the initial 93 patients died, half of them because of infectious complications. CONCLUSION: Infectious complications are frequent, become early and are potentially severe. Imputability to rituximab is not certain. However, this could lead to better codify rituximab prescriptions and take adapted and associated measures in order to facilitate infection prevention and, if an infection does occur, to treat it at the earliest stage possible. The age doesn't seem to be a risk factor.