This study was aimed to analyze the serological characteristics, efficacy and safety of incompatible RBC transfusion in patients with autoimmune hemolytic anemia (AIHA). The patients with idiopathic or secondary AIHA were analyzed retrospectively, then the serological characteristics and the incidence of adverse transfusion reactions were investigated, and the efficacy and safety of incompatible RBC transfusion were evaluated according to the different autoantibody type and infused different RBC components. The results showed that out of 61 cases of AIHA, 21 cases were idiopathic, and 40 cases were secondary. 8 cases (13.1%) had IgM cold autoantibody, 50 cases (82.0%) had IgG warm autoantibody, and 3 cases (4.9%) had IgM and IgG autoantibodies simultaneously. There were 18 cases (29.5%) combined with alloantibodies. After the exclusion of alloantibodies interference, 113 incompatible RBC transfusions were performed for 36 patients with AIHA, total efficiency rate, total partial efficiency rate and total inefficiency rate were 56.6%, 15.1% and 28.3%, respectively. Incompatible RBC transfusions were divided into non-washed RBC group and washed RBC group. The efficiency rate, partial efficiency rate and inefficiency rate in non-washed RBC group were 57.6%, 13.0% and 29.4%, respectively. The efficiency rate, partial efficiency rate and inefficiency rate in washed RBC group were 53.6%, 21.4% and 25.0%, respectively. There was no significant difference of transfusion efficacy (P > 0.05) in two groups. Incompatible RBC transfusions were also divided into IgM cold autoantibody group and IgG warm autoantibody group. The efficiency rate, partial efficiency rate and inefficiency rate in IgM cold autoantibody group were 46.2%, 30.8% and 29.4%, respectively. The efficiency rate, partial efficiency rate and inefficiency rate in IgG warm autoantibody group were 56.7%, 13.4% and 29.9%, respectively. There was no significant difference of transfusion efficacy (P > 0.05 ) in two groups. Hemolytic transfusion reaction was not observed in all incompatible RBC transfusions. It is concluded that the same ABO type of non-washed RBC transfusion and O type washed RBC transfusion are all relatively safe for the AIHA patients with severe anemia after the exclusion of alloantibodies interference. There is no significant difference of transfusion efficacy in two groups. The same ABO type of non-washed RBC transfusion is more convenient and efficient than washed RBC transfusion, and excessive use of type O RBCs can also be avoided.
Adult ; Aged ; Aged, 80 and over ; Anemia, Hemolytic, Autoimmune ; diagnosis ; immunology ; therapy ; Blood Grouping and Crossmatching ; Erythrocyte Transfusion ; Female ; Humans ; Isoantibodies ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Anemia, Hemolytic, Autoimmune ; complications ; immunology ; pathology ; Antibodies ; immunology ; Female ; Humans ; Lymphoma, Non-Hodgkin ; etiology ; immunology ; pathology ; Male ; Middle Aged

The irregular antibodies are other than antibodies from ABO blood group system because of pregnancies and blood transfusions, clinical autoimmune, drug-induced etc. The irregular IgG and/or IgM antibodies emerge and lead to the difficult identification of clinical blood type, difficult matching of blood, hemolytic disease of newborn, hemolytic transfusion reaction, and so on. It is very necessary to screen and identify the irregular antibodies before blood transfusion or antepartum. For some difficult identifying samples, some detections on serological level should be done firstly, combining with flow cytometry analysis, the difficult-matching patients' genotypes and fetal genotypes were detected by molecular biology techniques such as PCR and PCR-SSP in order to further predict fetal hemolytic disease of newborn and to provide the right blood to difficult-matching patients, and free fetal DNA extracted from maternal plasma. So that some measures must early be taken for clinical prevention and treatment to reduce immune hemolytic reactions. In this paper, the emergence of irregular antibodies, species, laboratory testing, pathogenesis, clinical symptoms and the current research are reviewed.
Anemia, Hemolytic, Autoimmune ; etiology ; immunology ; Erythroblastosis, Fetal ; etiology ; immunology ; Female ; Humans ; Infant, Newborn ; Isoantibodies ; adverse effects ; immunology ; Pregnancy ; Transfusion Reaction

OBJECTIVETo investigate the quantities of bone marrow CD5+ B lymphocytes in the patients with autoimmune hemocytopenia and the relationship between quantities of CD5+ B lymphocytes and clinical or laboratorial parameters.

METHODSQuantities of CD5+ B lymphocytes in the bone marrow of 14 patients with autoimmune hemolytic anemia (AIHA) or Evans syndrome, 22 immunorelated pancytopenia (IRP) patients, and 10 normal controls were assayed by flow cytometry. The correlation between their clinical or laboratorial parameters and CD5+ B lymphocytes was analyzed.

RESULTSThe quantity of CD5+ B lymphocytes of AIHA/Evans syndrome (34.64% +/- 19.81%) or IRP patients (35.81% +/- 16.83%) was significantly higher than that of normal controls (12.00% +/- 1.97%, P < 0.05). However, there was no significant difference between AIHA/Evans syndrome and IRP patients (P > 0.05). In all hemocytopenic patients, the quantity of bone marrow CD5+ B lymphocytes showed significantly negative correlation with serum complement C3 level (r = -0.416, P < 0.05). In the patients with AIHA/Evans syndrome, the quantity of bone marrow CD5+ B lymphocytes showed significantly positive correlation with serum indirect bilirubin level (r = 1.00, P < 0.05). In Evans syndrome patients, the quantity of CD5+ B lymphocytes in bone marrow showed significantly positive correlation with platelet-associated immunoglobulin G (r = 0.761, P < 0.05) and platelet-associated immunoglobulin M ( r = 0.925, P < 0.05). The quantity of CD5+ B lymphocytes in bone marrow of all hemocytopenic patients showed significantly negative correlation with treatment response (tau-b = -0.289, P < 0.05) , but had no correlation with colony forming unit-erythroid (r = -0.205, P > 0.05) or colony forming unit-granulocyte-macrophage colonies (r = -0.214, P > 0.05).

CONCLUSIONSThe quantity of bone marrow CD5+ B lymphocytes in the patients with autoimmune hemocytopenia significantly increases and is correlated with disease severity and clinical response, which suggest that CD5+ B lymphocytes might play an important role in the pathogenesis of autoimmune hemocytopenia.

Anemia, Hemolytic, Autoimmune ; drug therapy ; immunology ; Autoimmune Diseases ; drug therapy ; immunology ; B-Lymphocytes ; classification ; immunology ; Cyclosporine ; therapeutic use ; Drug Therapy, Combination ; Flow Cytometry ; Glucocorticoids ; therapeutic use ; Humans

To observe the therapeutic effect and safety of rituximab (anti-CD20 monoclonal antibody) in the treatment of refractory autoimmune hemolytic anemia (AIHA). One AIHA patient refractory to corticosteroid and splenectomy was treated with rituximab, 375 mg/m(2) weekly for four times. Her hemolytic symptoms, adverse effects, hemoglobin (Hb) concentration and other laboratory data were monitored. The results showed that concentration of lactic dehydrogenase (LDH), total bilirubin (TBIL) and indirect bilirubin (IBIL) began to decrease at 11 days after the first dose of rituximab, and decreased to normal range after 45 days. Concentration of hemoglobin increased up to 95 - 100 g/L. The patient remained disease-free 4 months after treatment. No adverse effect was found during the process of treatment. It is concluded that anti-CD20 monoclonal antibody (rituximab) is both effective and safe for the treatment of refractory autoimmune hemolytic anemia.
Anemia, Hemolytic, Autoimmune ; drug therapy ; Antibodies, Monoclonal ; therapeutic use ; Antibodies, Monoclonal, Murine-Derived ; Antigens, CD20 ; immunology ; Female ; Humans ; Middle Aged ; Rituximab

OBJECTIVETo study the clinical characteristics of autoimmune hemolytic anemia (AIHA) with both warm and cold autoantibodies.

METHODSClinical and laboratory characteristics of 23 cases of AIHA with both warm and cold autoantibodies admitted to our hospital between January 1994 and April 2004 were analyzed retrospectively.

RESULTSIn comparison with the AIHA patients with both warm and cold autoantibodies in the 1980s, the present patients showed the following features: The proportion of this kind AIHA in all AIHA patients increased from 17.6% to 22.1%. There were more females, more primary cases (73.9%), more mixed subtypes of autoantibodies and more of IgM (56.5%). The hemolysis was related with thermal amplitude of autoantibodies and quantity of complement. The response to cortisone and other immunosuppressive drugs was good. The relapse rate was 77.8% in a median follow-up time of 4 months.

CONCLUSIONSAIHA with both warm and cold autoantibodies is related with the type and thermal amplitude of the autoantibody and the activation of complement. It can be treated effectively with combined immunosuppressive therapy, but the relapse rate is high.

Adolescent ; Adult ; Aged ; Anemia, Hemolytic, Autoimmune ; drug therapy ; immunology ; Autoantibodies ; immunology ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin M ; immunology ; Male ; Middle Aged ; Treatment Outcome

Agglutinins ; immunology ; Anemia, Hemolytic, Autoimmune ; Humans ; Immunoglobulin G ; Infant, Newborn

To observe of alloantibodies of patients with autoimmune hemolytic anemia (AIHA), the alloantibodies masked by autoiantibody were detected by using chloroquine elution test, and the specificity of autoantibody was identified by ether elution test. The results showed that 19 cases out of 38 patients with AIHA were positive detected by indirect antiglobulin test and in 7 cases of them alloantibodies in sera cases were found (1 case of anti-D, 4 cases of anti-E and 2 cases of anti-CE), in 5 cases of them alloantibody were detected carried blood group specificity (3 cases of anti-E, anti-C and anti-c 1 case respectively). In conclusion, detections of alloantibodies by chloroquine elution test and ether elution test were very important for transfusion safety in therapy of patients with AIHA.
ABO Blood-Group System ; Adolescent ; Adult ; Anemia, Hemolytic, Autoimmune ; immunology ; Autoantibodies ; blood ; Blood Grouping and Crossmatching ; methods ; Erythrocytes ; immunology ; Female ; Humans ; Isoantibodies ; blood ; Male ; Middle Aged ; Rh-Hr Blood-Group System

The primary ovarian lymphoma is a rare disease with poor prognosis. The incidence of autoimmune hemolytic anemia in patients with non-Hodgkin's lymphoma is estimated at 3%. However, a substantial portion of the previously reported cases of ovarian lymphoma actually represented ovarian involvement by more diffuse lymphomatous process. If stringent criteria are used for case selection, true primary ovarian lymphoma usually carries a favorable prognosis. We present a primary malignant lymphoma of ovary accompanied by autoimmune hemolytic anemia in a 29-yr-old patient. After ablative surgery, the hemoglobin level and the reticulocyte count were normalized. One year following surgery and chemotherapy, the patient is alive and disease free.
Adult ; Anemia, Hemolytic/*immunology ; Antineoplastic Agents, Hormonal/therapeutic use ; Autoimmune Diseases/immunology ; Combined Modality Therapy ; Female ; Human ; Lymphoma, Non-Hodgkin/*complications/drug therapy/pathology/surgery ; Ovarian Neoplasms/*complications/drug therapy/pathology/surgery ; Prednisolone/therapeutic use

OBJECTIVETo analyse the relapse rate and risk factors of autoimmune hemolytic anemia (AIHA) and Evans syndrome.

METHODSFifty two cases of AIHA and Evans syndrome in remission being followed up for 1 - 14 years (median time 3.8 years) were analysed for relapse rate. The risk factors of relapse were analysed by case-control study.

RESULTSThe total relapse rate of these AIHA and Evans syndrome patients was 57.7%, and the median remission duration to the first relapse was 9 months. The relapse rates in patients with negative Coombs test, warm autoantibodies and both of warm and cold autoantibodies were 30.8% (4/13), 54.0% (13/24) and 86.7% (13/15), respectively. The relapse rate in patients with cold antibody was the highest (P < 0.05). The relapse rate in patients with antibody titer >or= 100 was 92.9% (13/14) and was higher than that in patients with antibody titer < 100 [59.5% (13/22)] (P < 0.05). Patients treated with prednisone and cyclosporin relapsed less than those treated with prednisone alone, and the relapse was related to the therapy course of prednisone and CsA.

CONCLUSIONBecause of the high relapse rate, AIHA and Evans syndrome should be treated according to the class of autoantibodies, and with longer course of prednisone and cyclosporin and prophylaxis of infection.

Adolescent ; Adult ; Aged ; Anemia, Hemolytic, Autoimmune ; etiology ; immunology ; Autoantibodies ; blood ; Child ; Cyclosporine ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Prednisone ; therapeutic use ; Recurrence ; Risk Factors ; Syndrome ; Thrombocytopenia ; etiology ; immunology