Prognosis of autoimmune hemolytic anemia in critically ill patients
Prognosis of autoimmune hemolytic anemia in critically ill patients
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DOI：
10.1007/s00277-018-3553-9
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发表时间：
2019-03-01
影响因子：
3.5
通讯作者：
Mariotte, E.
中科院分区：
文献类型：
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作者：
Lafarge, Antoine;Bertinchamp, R.;Mariotte, E.
自身免疫性溶血性贫血（AIHA）患者可能需要入住重症监护室（ICU）。为了描述ICU中AIHA患者的特征并确定预后因素，回顾性分析了2002年至2015年期间在一个ICU中收治的44例患者的临床和生物学数据。19例患者入住ICU的主要原因是深度贫血，无任何器官衰竭（仅为了更安全的输血或持续监测）。25例（57%）患者既往有血液病史。20例患者的直接抗球蛋白试验（DAT）仅对免疫球蛋白G（DAT-IgG）呈阳性（46%），8例患者的DAT对IgG和补体均呈阳性（DAT-IgG +C）（36%），16例患者的DAT仅对补体呈阳性（DAT-IgG +C）（18%）。皮质类固醇和利妥昔单抗分别给予44例（100%）和12例（25%）患者。28例（64%）患者需要输注红细胞。10例（23%）患者接受血管加压药治疗。14例（31.8%）患者需要肾脏替代治疗。13例（30%）患者在ICU死亡。存活者和非存活者之间的相关合并症（如血液病）无差异（18/31 [58%] vs. 7/13 [54%]，p=0.80）。在死亡者中，年龄较高（72岁[57.8-76.3] vs. 50岁[34.3-64]，p
Patients with autoimmune hemolytic anemia (AIHA) may require intensive care unit (ICU) admission. In order to describe the characteristics of AIHA patients in ICU and identify prognosis factors, clinical and biological data from 44 patients admitted in one ICU between 2002 and 2015 were retrospectively analyzed. The main reasons for ICU admission were profound anemia without any organ failure in 19 patients (either for safer transfusion or continuous monitoring only). Twenty-five (57%) patients had a past history of hemopathy. Twenty patients presented with a direct anti-globulin test (DAT) positive for immunoglobulin G (DAT-IgG) only (46%), 8 with a DAT positive for both IgG and complement (DAT-IgG+C) (36%), and 16 with a DAT positive for complement only (DAT-IgG+C) (18%). Corticosteroids and rituximab were administered to respectively 44 (100%) and 12 (25%) patients. Red blood cell transfusion was required in 28 (64%) patients. Ten (23%) patients received vasopressors. Renal replacement therapy was necessary in 14 (31.8%) patients. Thirteen (30%) patients died in the ICU. There was no difference between survivors and non-survivors regarding associated comorbidities like hemopathy (18/31 [58%] vs. 7/13 [54%], p=0.80). In decedents, age was higher (72years [57.8-76.3] vs. 50years [34.3-64], p