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Clinical perspectives, immunohematologic insights, and transfusion management in IgA-associated autoimmune hemolytic anemia
, , et | 22 sept. 2022
À propos de cet article
Publié en ligne: 22 sept. 2022
Pages: 82 - 89
DOI: https://doi.org/10.21307/immunohematology-2022-047
© 2022 S.S. Das et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Fig. 1
Statistical analysis of in vivo hemolytic markers in study patients with IgA-associated and non-IgA-associated WAIHA (N = 214)
| IgA-associated WAIHA (N = 17) | Non-IgA-associated WAIHA (N = 197) | Statistics ( |
||
|---|---|---|---|---|
| Two-tailed |
95% Confidence interval | |||
| Hb (g/dL) | 5.58 ± 1.07 | 6.71 ± 1.16 | 0.0001 | –1.701 to –0.553 |
| Hct (%) | 16.9 ± 2.73 | 19.5 ± 3.32 | 0.002 | –4.232 to –0.971 |
| Retic (%) | 9.13 ± 2.39 | 7.38 ± 1.93 | 0.0005 | 0.769 to 2.732 |
| S.Bil (mg/dL) | 4.63 ± 1.54 | 3.52 ± 1.93 | 0.022 | 0.165 to 2.051 |
| LDH (IU/L) | 967.5 ± 258.9 | 793.2 ± 269.3 | 0.010 | 40.692 to 208.317 |
Cl nohematologic, and transfusion characteristics of study patients with IgA-associated and non-IgA-associated WAIHA (N = 214)
| Characteristics | IgA-associated WAIHA ( |
Non-IgA-associated WAIHA ( |
|
|---|---|---|---|
| Age in years (range) | 50 (27–68) | 43 (20–71) | — |
| Sex (male:female) | 1:1.4 | 1:1.7 | 0.736 |
| Primary WAIHA | 6 (35.3) | 81 (41.1) | 0.639 |
| Secondary WAIHA | 11 (64.7) | 116 (58.9) | |
| Lymphoproliferative disease | 6 (35.3) | 67 (34.1) | — |
| Systemic lupus erythematosus | 3 (17.6) | 22 (11.2) | — |
| Rheumatoid arthritis | 1 (5.9) | 14 (7.1) | — |
| Autoimmune hepatitis | 1 (5.9) | 4 (2) | — |
| Glomerulonephritis | 0 | 5 (2.5) | — |
| Thyrotoxicosis | 0 | 2 (1) | — |
| Polyarthritis nodosa | 0 | 1 (0.5) | — |
| Sarcoidosis | 0 | 1 (0.5) | — |
| Fever | 5 (29.4) | 34 (17.2) | 0.213 |
| Jaundice | 4 (23.5) | 33 (16.7) | 0.478 |
| Organomegaly | 7(41.2) | 71 (36) | 0.672 |
| Palpitation | 10 (58.8) | 102 (51.8) | 0.576 |
| Dyspnea | 7(41.2) | 65 (33) | 0.493 |
| DAT positive | 17 (100) | 197 (100) | — |
| DAT <2 + | 0 (0) | 61 (31) | 0.0067 |
| DAT ≥2+ | 17 (100) | 136 (69) | |
| DAT strength | 4+ (1+ to 4+) | 3+ (1+ to 4+) | — |
| IAT positive | 15 (88.2%) | 128 (65%) | — |
| IAT <2+ | 0 (0) | 48 (37.5) | 0.0036 |
| IAT ≥2+ | 15 (100) | 80 (62.5) | |
| IAT strength | 4+ (1+ to 4+) | 2+ (1+ to 4+) | — |
| Autocontrol strength | 3+ (1+ to 4+) | 2+ (1+ to 4+) | — |
| Blood group discrepancy | 1 (5.9) | 9 (4.6) | 0.805 |
| Patients with new alloantibody | 1 (5.9) | 14 (7.1) | 0.849 |
| Patients transfused ( |
15 (88.2) | 86 (43.7) | 0.0004 |
| PRBC units crossmatched ( |
118 | 309 | — |
| PRBC units transfused ( |
32 | 123 | — |
| Compatible PRBC units transfused | 5 (15.6) | 99 (80.5) | 0.983 |
| “Least incompatible” PRBC units transfused | 27 (84.4) | 24 (19.5) | |
| PRBC units transfused per patient (mean ± SD) | 2.13 ± 0.92 | 1.43 ± 0.68 | — |
| Transfusion reaction | 2 (11.8) | 15 (7.6) | 0.543 |
| History of previous transfusion | 11 (64.7) | 107 (54.3) | 0.408 |
Demographic, laboratory, and immunohematologic characteristics of study patients with IgA-associated WAIHA (N = 17)
| Patient no. | Demographics | Laboratory values | Immunohematologic details | Transfusion (PRBC units) | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Age (years) | Sex | Hb (g/dL) | Retic (%) | S.Bil (mg/dL) | LDH (IU/L) | DAT (poly) | DAT (mono) | IAT | ||
| 1 | 68 | M | 6.7 | 5.5 | 3.4 | 798 | 4+ | IgG+IgA | 3+ | 1 |
| 2 | 53 | M | 7.1 | 5 | 2.8 | 654 | 3+ | IgG+IgA | 2+ | None |
| 3 | 55 | F | 5.9 | 6.1 | 3.9 | 880 | 4+ | IgG+IgA | 3+ | 2 |
| 4 | 43 | F | 4.8 | 9.5 | 5.1 | 1102 | 4+ | IgA | 0 | 2 |
| 5 | 52 | F | 3.5 | 12.6 | 7.2 | 1349 | 4+ | IgG+IgA+C3 | 4+ | 3 |
| 6 | 50 | F | 5.9 | 8.2 | 4.1 | 901 | 4+ | IgG+IgA | 4+ | 2 |
| 7 | 39 | F | 5.5 | 7.9 | 4 | 873 | 4+ | IgG+IgA | 4+ | 2 |
| 8 | 37 | M | 6.4 | 6.6 | 3.3 | 995 | 3+ | IgG+IgA | 3+ | 2 |
| 9 | 60 | M | 7.3 | 5.1 | 3.1 | 709 | 3+ | IgG+IgA | 2+ | None |
| 10 | 51 | F | 4.6 | 10.2 | 7.3 | 1512 | 4+ | IgA | 0 | 3 |
| 11 | 29 | F | 5.1 | 7.8 | 5.1 | 893 | 4+ | IgG+IgA | 3+ | 2 |
| 12 | 59 | M | 3.9 | 13.4 | 6.9 | 1334 | 4+ | IgG+IgA+C3 | 4+ | 3 |
| 13 | 41 | F | 5.7 | 7.7 | 4.5 | 921 | 4+ | IgG+IgA | 4+ | 2 |
| 14 | 35 | M | 6.2 | 6.8 | 4 | 605 | 4+ | IgG+IgA | 3+ | 1 |
| 15 | 27 | F | 5.5 | 8.1 | 3.7 | 819 | 4+ | IgG+IgA | 4+ | 2 |
| 16 | 57 | M | 5.8 | 8 | 3.4 | 843 | 4+ | IgG+IgA | 3+ | 2 |
| 17 | 41 | F | 4.4 | 9.8 | 7 | 1260 | 4+ | IgG+IgA+C3 | 4+ | 3 |