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Evans syndrome (ES) is a spectrum of diseases in which the combination of autoimmune hemolytic anemia and immune thrombocytopenia or sometimes neutropenia. ES has been accepted usually as an idiopathic condition, but it may be secondary. The coexistence of autoimmune cytopenias and Hodgkin lymphoma (HL) is rarely observed and the rate of ES in HL patients is not clear. Here we describe a 56-year-old male patient who presented with ES and was diagnosed with HL. After corticosteroids, intravenous immunoglobulin (IVIG) and ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) treatment, immune cytopenias were completely resolved. The literature is also reviewed and we found 16 cases in which HL and ES coexist. Although AIHA and immune thrombocytopenia usually develop simultaneously, they rarely occur at different times. Many aspects of the pathogenesis are unknown, but it is thought to be a complex immunological background. Corticosteroids and/or IVIG are the most commonly used first-choice drugs in the initial treatment of ES. Response rates to treatment are variable and response to treatment may be poor, particularly with underlying conditions. If detected, the underlying lymphoma should be treated. [ABSTRACT FROM AUTHOR]

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Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Argentina de Terapia Intensiva is the property of Sociedad Argentina de Terapia Intensiva (SATI) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: giant cell hepatitis with autoimmune hemolytic anemia (GCH-AIHA) is a rare and serious condition that usually occurs during the first year of life. There is no specific diagnostic test; it is histologically characterized by a transformation of hepatocytes into giant cells. Case presentation: male patient who at 45 days-old starts with jaundice, pallor, and hepatomegaly. Leukocytosis, normocytic anemia with positive direct Coombs, and elevation of bilirubin, lactate dehydrogenase and transaminases were found. Serology for syphilis, toxoplasma, rubella, cytomegalovirus, and herpes simplex were negative. Diagnosis was established by histopathological findings in liver biopsy, plus hemolytic anemia. The patient was treated with steroids and azathioprine, and has maintained a satisfactory evolution until the age of eight years, without relapses, and improvement of the histopathological pattern. Conclusions: GCH-AIHA is a serious disease, which should be suspected in infants with hemolytic anemia, plus evidence of acute hepatitis, after ruling out the main causes of hepatitis. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is still propagating a year after the start of the pandemic. Besides the complications patients face during the COVID-19 disease period, there is an accumulating body of evidence concerning the late-onset complications of COVID-19, of which autoimmune manifestations have attracted remarkable attention from the first months of the pandemic. Autoimmune hemolytic anemia, immune thrombocytopenic purpura, autoimmune thyroid diseases, Kawasaki disease, Guillain-Barre syndrome, and the detection of autoantibodies are the cues to the discovery of the potential of COVID-19 in inducing autoimmunity. Clarification of the pathophysiology of COVID-19 injuries to the host, whether it is direct viral injury or autoimmunity, could help to develop appropriate treatment. [ABSTRACT FROM AUTHOR]

Resumen Introducción El síndrome de Evans se caracteriza por la disminución de, al menos, dos líneas celulares en ausencia de otros diagnósticos. Anteriormente, se definía como el desarrollo simultáneo o secuencial de trombocitopenia inmune primaria y anemia hemolítica autoinmune sin etiología específica. Se ha reportado una incidencia del 37% y una mortalidad del 10% de este síndrome. Casos clínicos Se presenta la información clínica y la evolución del síndrome de Evans en dos pacientes lactantes que inicialmente fueron diagnosticados con trombocitopenia inmune primaria. El diagnóstico clínico se apoyó con estudios de gabinete, donde se corroboraron las alteraciones hematológicas. El manejo se realizó con esteroides e inmunoglobulina. Conclusiones En el abordaje del paciente pediátrico con trombocitopenia se deben buscar alteraciones de otra línea celular. En los casos reportados se detectó la presencia de anemia hemolítica y monocitosis, por lo que se deben incluir estudios infecciosos e inmunológicos. El tratamiento de primera línea es con esteroides, y debe considerarse la administración de inmunoglobulina si existe trombocitopenia severa asociada, como se observó en estos casos. Background Evans syndrome is characterized by the reduction of at least two blood cell lineages in the absence of other diagnoses; it was previously described as the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia with unknown etiology. An incidence of 37% and mortality rate of 10% were reported for Evans syndrome. Clinical cases We report the clinical presentation and evolution of Evans syndrome in two infants who were initially diagnosed with immune thrombocytopenia. The clinical diagnosis was supported on complementary studies, where hematological disorders were corroborated. Both cases received treatment with steroids and intravenous immunoglobulin. Conclusions For the management of children with thrombocytopenia, the pediatrician must analyze for other cell lineage disorders. In the cases that we report here, we found the presence of autoimmune hemolytic anemia and monocytosis. Therefore, infectious and immunological studies must be included. The first-line treatment of choice are steroids, and intravenous immunoglobulin can be considered if severe immune thrombocytopenia is associated, as observed in these cases. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical characteristics of patients with autoimmune hemolytic anemia in a private clinic in the city of Medellin. Materials and methods: Retrospective descriptive study of seven cases of AHA that were treated at private clinic in the city of Medellin (Colombia) between 2005 and 2010. The information was taken from the patients' clinical history. Results: 6 of the 7 cases were women, the median age was 47 years (minimum 21 and maximum 74). The most frequent concomitant diseases were SLE and infectious with 3 cases each one. The therapy is based primarily on the use of glucocorticoids with 4 cases found and never resorted to biological therapy. Two patients required change of its treatment. Conclusion: This study shows the clinical and demographic findings of a small number of adult cases with AHA. National studies are needed greater geographic coverage to help establish the true incidence of this disease and describe the main clinical and epidemiological characteristics. [ABSTRACT FROM AUTHOR]

The autoimmune hemolytic anemias antibody can be hot or cold, have an incidence of 70 to 80% may be idiopathic in 50 to 60% and the rest of the cases secondary to lymphoproliferative disorders, collagen disease, drugs, solid tumors, infections and inlammatory bowel disease. Case: 27 year old male starts with a runny nose, rhinolalia, malaise so Treating yourself with ampicillin 500 mg every 6 hrs x 3 days. Then drink alcohol and generalized jaundice, myalgia, arthralgia, predominantly in the hands and knees, symmetrical, nausea, vomiting and hematemesis on two occasions. Physical examination BP 90/60, HR 110, FR 16, temperature 37.7 ∞, oriented with generalized paleness of skin, icteric sclerae, mucous membranes dehydrated, parotid hypertrophy, short neck, without lymphadenopathy. Thorax with anterior axillary lymphadenopathy in 2 cm and painless. Abdomen globose at the expense of adipose tissue, liver edge was palpable 3 cm below the costal margin, soft in consistency, smooth, tender, palpable spleen 2 cm below the left costal margin, non tender, bloat in colonic frame, peristalsis of 6 per minute. Limbs without swelling or pain in joints without deformity, with preserved muscle strength and tone, capillary reill 3 seconds without edema. Leukocyte 16400, 13 300 neutrophils, lymphocytes 2530, monocytes 350, 105 eosinophils, basophils, 109, 3.82 Hb, Hct 8.07, MCV 96.8, platelets 103 000 CMH45. glucose 207, l7 BUN, creatinine 1.1, Na 133, K 3.63, Cl 108, total protein 6.3, albumin 3.6, cholesterol 120, calcium 7.8, PO2 1.1, Mg 2.6, BD 1.7 BT 9.2, BI 7.5, AST 59 ALT 78 LDH GGT 903 51. 05/04/1910: TP 15.8 seconds, PTT 22.2 seconds. Direct Coombs: positive. Peripheral blood smear: promyelocytes 1%, leukocyte cell 2 monositos 3%, neutrophils 94%, 72% erythroblasts in 100 leukocytes, has corrected WBC 20.8 x 10 3 / ml, macrocytosis and diffuse basophilia. With ESR 45 mm / m PCR rheumatoid factor 55 and 12.7 IU / ml. 05/10/1910. Packed red blood cells with Rh incompatibility so are washed and packed red blood cells are transfused in February because the patient is anemic data cor. Persisting with hemolysis data. Immunological proile are requested to report: Anti Nuclear Ab negative, anti-Smith Ab negative 3.6, positive Anti cyclic citrullinated peptide 88.1. U / ml. Management starts with pulses of methylprednisolone and metotrextate showing improvement. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: pregnant women with Rh alloimmunization (RhA) are submitted to invasive procedures to assess fetal anemia (FA). Recently a non-invasive approach to FA diagnosis has been proposed using Doppler ultrasound (DU) to identify increased peak velocity of systolic blood flow (Vm) in the middle cerebral artery (MCA). Methodology: eleven Rh alloimmunized pregnant women with serum red-cell anti-body titers > 1:16 were included. Twenty-four procedures were done measuring the VmMCA followed by cordocentesis and fetal hemoglobin (FH) analysis. Pearson's linear correlation was calculated between the multiples of the median (MoM) of the VmMCA and the MoM of the FH, as well as the sensitivity, specificity and positive predictive value (PPV) for FA prediction. Results: we found FA (FH mean = 6 g/dL) in 12 of 24 evaluations with a VmMCA mean of 1.5 MoM and a range from 1.22 to 1.68 MoM; in the remaining 12 cases the FH was normal (FH mean = 13.1 g/dL) with a VmMCA mean of 0.97 MoM and a range from 0.35-1.17 MoM ( p < 0.001). Eleven fetuses with anemia had a MoM of the VmMCA above 1.29, except one with 1.22 MoM. The linear correlation between the MoM of the VmMCA and the MoM of FH was 0.83. The sensitivity of the MoM of the VmMCA to detect FA was 91%, specificity of 100% and PPV of 100%. Conclusions: DU measurement of the Vm-MCA was a useful non-invasive technique to evaluate FA. The sensitivity and PPV for FA diagnosis in RhA was above 90%. [ABSTRACT FROM AUTHOR]

The hematological disorders are frequent in HIV infection; however the hemolytic anemia is a rare complication in pediatric patients. At this moment exist less than ten cases reported in medical literature. The authors reported a four month old girl with perinatal docu-mented infection by HIV associated to autoimmune hemolytic anemia, and they propose a critic route for diagnosis and initial treatment. [ABSTRACT FROM AUTHOR]