Mehmet Ali UCAR, Simten DAGDAS, Funda CERAN, Mesude FALAY, Gulsum OZET

Variability of Findings Due to Seasonal Alterations and Number of Attacks in Warm-Type Autoimmune Hemolytic Anemia

Background: In this study, an examination of the variability of findings due to seasonal alterations and variability of the number of attacks in warm-type autoimmune hemolytic anemia AIHA was aimed. Method: Patients over 18 years of age who were admitted to Ankara Numune Training and Research Hospital between 2009 and 2017 and were diagnosed with warm-type AIHA were included in this retrospective study. For statistical evaluation, SPSS 20 for Windows was used. For comparison of categorical data, chi-square and Fisher exact chi-square tests were used. Results: The study population comprised of 52 patients. The age range of the patients was 19-89 years, with a median of 45.5 years. Among the patients, the number of attacks was 1 in 63.5% n=33 , 2 in 15.4% n=8 , and 3 in 21.2% n=11 . The type of AIHA was the warm type in all of the patients. In regard to the season during which attacks were experienced, it was determined to be winter in 26.9% n=14 , autumn in 17.3% n=9 , summer in 38.5% n=20 , and spring in 17.3% n=9 of the patients. The rate of attacks was determined to be higher during winter in the patient group with a number of attacks of 2 or more and during summer and autumn in the patient group with the number of attacks of 1 p=0.030 . Conclusion: It was determined that, while the rate of patients who experienced only 1 AIHA attack increased during the summer and autumn seasons, attacks occurred most commonly during winter in patients with more than 1 attack.

Keywords:

Autoimmune hemolytic anemia, seasonal alteration, antibody,

PDF

___

1. Barcellini W, Fattizzo B, Zaninoni A, et al. Clinical heterogeneity and predictors of outcome in primary auto immune hemolytic anemia: a GIMEMA study of 308 patients. Blood 2014;124:2930-6
2. Petz LD, Garratty G. Immune hemolytic anemias. 2nd ed. Philadelphia, PA: Churchill Livingstone, 2004
3.Gehrs BC, Friedberg RC. Autoi mmune hemolyticanemia. Am J Hematol 2002;69:258-71
4. Sokol RJ, Hewitt S, Booker DJ, Stamps R. Enzyme linked direct antiglobulin tests in patients with autoimmune haemolysis. J Clin Pathol. 1985;38:912–4
5. Lynen R, Krone O, Legler TJ, Köhler M, Mayr WR. A newly developed gel centrifugation test for quantification of RBC-bound IgG antibodies and their subclasses IgG1 and IgG3: Comparison with flow cytometry. Transfusion. 2002;42:612–8
6. Sokol RJ, Hewitt S, Stamps BK. Autoimmune haemolysis: An 18-year study of 865 cases referred to a regional transfusion centre. Br Med J (ClinResEd) 1981;282:2023–7
7. Petz LD, Garratty G. New York: Churchill Livingstone; 1980. AcquiredImmuneHemolyticAnemias
8. Engelfriet CP, Overbeeke MA, von dem Borne AE. Auto immune hemolytic anemia. Semin Hematol. 1992;29:3–12
9.Garratty G. Factors affecting the pathogenicity of red cell auto and alloantibodies. In: Nance SJ, editor. Immune Destruction of Red Blood Cells. Arlington, VA: American Association of Blood Banks; 1989. p. 109
10. Ness PM, Shirey RS, Thoman SK, Buck SA. The differentiation of delayed serologic and delayed hemolytic transfusion reactions: Incidence, long-term serologic findings, and clinical significance. Transfusion. 1990;30:688–93
11. Barcellini W, Revelli N, Imperiali FG, et al. Comparison of traditional methods and mitogen-stimulated direct antiglobulin test for detection of anti-red blood cell autoimmunity. Int J Hematol 2010;91:762-9
12. Valesini G, Gerardi MC, Iannuccelli C, Pacucci VA, Pendolino M, Shoenfeld Y. Citrullination and autoimmunity, Autoimmun. Rev. 14 (6) (2015) 490-497
13. Medeot M, Zaja F, Vianelli N et al. Rituximab therapy in adult patients with relapsedor refractory immune thrombocytopenic purpura: long- termfollow-upresults. Eur J Haematol 2008; 81: 165–9
14. Sokol RJ, Hewitt S, Stamps BK. Autoimmune hemolysis: Mixed warm and cold antibody type. Acta Haematol. 1983;69:266–74
15. O’Connor BM, Clifford JS, Lawrence WD, Logue GL. Alpha-interferon for severe cold agglutinin disease. Ann Intern Med. 1989;111:255–6
16. Frieri M, Stampfl H. Systemic lupus erythematosus and atherosclerosis: review of the literature, Auto immun. Rev. 15 (1) (2016) 16-21
17. Duarte-Garcia A, Fang H. Seasonal variation in the activity of systemic lupus erythematosus, J. Rheumatol. 39 (7) (2012) 1392-1398
18. Kimpimaki T, Kupila A, Hamalainen AM et al. The first signs of beta-cell auto immunity appear in infancy in genetically susceptible children from the general population: the Finnish Type 1 Diabetes Prediction and Prevention Study, J. Clin. Endocrinol. Metabol. 86 (10) (2001) 4782-4788
19. Parfitt AM, Gallagher JC, Heaney RP, Johnston CC, Neer R, Whedon GD. Vitamin D and bone health in the elderly, Am. J. Clin. Nutr. 36 (5 Suppl) (1982) 1014-1031
20. RozinA, Balbir-Gurman A, SchapiraD. Seasonal distribution of relapse onset in rheumatoid arthritis and spondylo arthropathy: the possible effect of the solar factor, Clin. Exp. Rheumatol. 21 (2) (2003) 161-169
21. Tombak A, Boztepe B, Tiftik N, Cömert M, Salim O, Aydın K, Gürkan E, Yücel OK, Saydam G, Sungur MA. Seasonal Association of Immune Thrombocytopenia in Adults. Balkan Med J. 2015 Oct;32(4):347-51
22. Kashiwagi H, Tomiyama Y. Pathophysiology and management of primary immune thrombocytopenia. Int J Hematol 2013;98:24-33
23. Olsson B, Andersson PO, Jernas M, Jacobsson S, Carlsson B, Carlsson LM, et al.T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med 2003;9:1123-4
24. Sakakura M, Wada H, Tawara I, Nobori T, Sugiyama T, Sagawa N, et al. Reduced Cd4 + Cd25 + T cells in patients with idiopathic thrombocytopenic purpura. Thromb Res 2007;120:187-93
25. Moulis G, Palmaro A, Montastruc JL, Godeau B, LapeyreMestre M, Sailler L. Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood 2014;124:3308-15
26. Moulis G, Sommet A, Sailler L, Lapeyre-Mestre M, Montastruc JL; French Association Of Pharmacovigilance Centers. Drug-induced immune thrombocytopenia: a descriptive survey in the French Pharmaco Vigilance database. Platelets 2012;23:490-4
27. Pedullá M, Fierro V, Papacciuolo V, Alfano R, Ruocco E. Atopy as a risk factor for thyroid autoimmunity in children affected with atopic dermatitis. J Eur Acad Dermatol Venereol 2014;28:1057-60