Page 883 - Clinical Immunology_ Principles and Practice ( PDFDrive )

CHaPter 62 Immunohematological Disorders 855

9
observed in 10.1%, and fetal platelet counts below 20 × 10 /L 6. Berentsen S, Randen U, Vagan AM, et al. High response rate and durable
42
were observed in 4.2%. The risk of intracranial hemorrhage remissions following fludarabine and rituximab combination therapy for
is below 1%, and the risk of fetal platelet count determination chronic cold agglutinin disease. Blood 2010;116:3180–4.
by either fetal scalp sampling or umbilical blood sampling likely 7. Petz LD. Immune hemolysis associated with transplantation. Semin
Hematol 2005;42:145–55.
exceeds the risk of fetal intracranial hemorrhage, negating its 8. Avent ND, Reid ME. The Rh blood system: a review. Blood
clinical utility. The mode of delivery has no impact on the 2000;95:375–87.
incidence of intracranial hemorrhage. 9. Mollison PL, Engelfriet CP, Contreras M. Immunology of red cells. In:
Platelet counts should be monitored for 1 week following Mollison PL, Engelfriet CP, Contreras M, editors. Blood transfusion in
delivery. In a study of 61 patients, 66% of neonates had a further clinical medicine. 10th ed. London: Blackwell Science; 1997. p. 60.
drop in platelets following delivery; the nadir occurred at day 10. Hughes-Jones NC. Red-cell antigens, antibodies and their interaction.
34
2, and the counts stabilized or began to rise at day 7. ASH Clin Haematol 1975;4:29–43.
guidelines recommend that children with a platelet count below 11. Petz LD, Garratty G. Mechanisms of immune hemolysis. In: Petz LD,
9
20 × 10 /L or those with hemorrhage be treated with IVIG. The Garratty G, editors. Immune hemolytic anemias. 2nd ed. Philadelphia,
concurrent use of corticosteroids is controversial because of the PA: Churchill Livingstone; 2004. p. 133.
risk of neonatal sepsis. Neonates with platelet counts below 50 12. Kurlander RJ, Rosse WF, Logue GL. Quantitative influence of antibody
and complement coating of red cells on monocyte-mediated cell lysis. J
9
× 10 /L should have brain imaging performed to detect occult Clin Invest 1978;61:1309–19.
intracranial hemorrhage. 13. Frank MM, Schreiber AD, Atkinson JP, et al. Pathophysiology of immune
hemolytic anemia. Ann Intern Med 1977;87:210–22.
On tHe HOrIZOn 14. Moise KJ. Red blood cell alloimmunization in pregnancy. Semin Hematol
2005;42:169–78.
• For many years immunosuppressive therapy for immune thrombocy- 15. Lechner K, Jager U. How I treat autoimmune hemolytic anemias in
topenic purpura (ITP) has consisted of corticosteroids and infusions adults. Blood 2010;116:1831–8.
of intravenous immunoglobulins (IVIGs), and more recently anti-Rh 16. Maheshwari A, Christensen RD, Calhoun DA. Immune-mediated
antibodies (in suitable candidates), and/or rituximab in patients whose neutropenia in the neonate. Acta Paediatr Suppl 2002;91:98–103.
disease is refractory to first-line therapy. Splenectomy may be indicated 17. Capsoni F, Sarzi-Puttini P, Zanella A. Primary and secondary
in those who fail medical therapy altogether.
• All ITP seems to be mediated by interaction of antibody-coated platelets autoimmune neutropenia. Arthritis Res Ther 2005;7:208–14.
with Fc receptors in the reticuloendothelial system of the spleen (and 18. Starkebaum G. Chronic neutropenia associated with autoimmune disease.
the liver). Many investigators have sought to interrupt the interaction Semin Hematol 2002;39:121–7.
between immunoglobulin (Ig)–coated platelets and Fcγ receptors by 19. Balint GP, Balint PV. Felty’s syndrome. Best Pract Res Clin Rheumatol
use of monoclonal antibodies to the Fcγ receptor itself. However, the 2004;18:631–45.
use of traditional murine monoclonal antibodies (mAbs) to Fcγ has 20. Mohan SJ, Maciejewski JP. Diagnosis and therapy of neutropenia in large
been associated with adverse events, perhaps as a result of cross-linking granular lymphocyte leukemia. Curr Opin Hematol 2009;16:27–34.
of Fcγ receptors on the surface of macrophages, resulting in undesirable 21. Lamy T, Loughran TP. How I treat LGL leukemia. Blood
immune stimulation and even anaphylaxis. One strategy to circumvent 2011;117:2764–74.
these problems would be to use monovalent Fab fragments that 22. Tesfa D, Keisu M, Palmblad J. Idiosyncratic drug-induced agranulocytosis:
would bind but not cross-link the Fcγ receptors. Yu et al. have reported Possible mechanisms and management. Am J Hematol 2009;84:428–34.
54
on the design of a monovalent fusion protein composed of the single 23. Grant C, Wilson WH, Dunleavy K. Neutropenia associated with
chain variable region (scFv) of the anti-FcγRIIIA antibody, fused to rituximab therapy. Curr Opin Hematol 2010;18:49–54.
human serum albumin so as to increase its size and prolong its half-life. 24. Bux J. Molecular nature of granulocyte antigens. Transfus Clin Biol
These investigators have shown in a mouse model of ITP that the 2001;8:242–7.
novel construct can prevent IgG-platelet interaction with FcγRIIIA 25. Bux J, Chapman J. Report on the second international granulocyte
receptors without harmful immune stimulation. If this can be replicated serology workshop. Transfusion 1997;37:977–83.
54
in larger animal models, it may be eventually tested for use in humans 26. Bruin MC, von dem Borne AE, Tamminga RY, et al. Neutrophil antibody
with ITP. Further, in theory this approach could be applied to other specificity in different types of childhood autoimmune neutropenia.
diseases, such as autoimmune hemolytic anemia.
Blood 1999;94:1797–802.
27. Bux J, Behrens G, Jaeger G, et al. Diagnosis and clinical course of
autoimmune neutropenia in infancy: analysis of 240 cases. Blood
Please check your eBook at https://expertconsult.inkling.com/ 1998;91:181–6.
for self-assessment questions. See inside cover for registration 28. Kobayashi M, Nakamura K, Kawaguchi H, et al. Significance of the
details. detection of anti-neutrophil antibodies in children with chronic
neutropenia. Blood 2002;99:3468–71.
REFERENCES 29. McCullough J, Weibler BJ, Clay M, et al. Effect of leukocyte antibodies on
the fate in vivo of indium-111-labelled granulocytes. Blood
1. Barros MM, Blajchman MA, Bordin JO. Warm autoimmune hemolytic 1981;58:164–70.
anemia: recent progress in understanding the immunobiology and 30. Morice WG, Kurtin PJ, Tefferi A, et al. Distinct bone marrow findings in
treatment. Transfus Med Rev 2010;24:195–210. T-cell granular lymphocytic leukemia revealed by paraffin section
2. Petz LD, Garratty G. Classification and clinical characteristics of immunoperoxidase stains for CD8. TIA-1, and granzyme B. Blood
autoimmune hemolytic anemias. In: Petz LD, Garratty G, editors. 2002;99:268–74.
Immune hemolytic anemias. 2nd ed. Philadelphia, PA: Churchill 31. Cines DB, Bussel JB, Liebman HA, et al. The ITP syndrome: pathogenic
Livingstone; 2004. p. 61. and clinical diversity. Blood 2009;113:6511–21.
3. Garratty G. Immune hemolytic anemia associated with drug therapy. 32. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of
Blood Rev 2010;24:143–50. terminology, definitions of outcome criteria in immune
4. Hoffman PC. Immune hemolytic anemia—selected topics. Hematology thrombocytopenic purport of adults and children: report from an
Am Soc Hematol Educ Program 2009;80–6. international working group. Blood 2009;113:2386–93.
5. McNicholl FP. Clinical syndromes associated with cold agglutinins. 33. Stavrou E, McCrea KR. Immune thrombocytopenia in pregnancy.
Transfus Sci 2000;22:125–33. Hematol Oncol Clin North Am 2009;23:1299–316.