[Evans' syndrome: a retrospective study from the ship (French Society of Pediatric Hematology and Immunology) (36 cases)].
Evans' Syndrome (ES) is defined as the combination of immune thrombocytopenia (ITP) and autoimmune haemolytic anemia (AIHA), in the absence of any known underlying etiology. Pathophysiology, epidemiology and outcome remain unclear.


METHODS
Thirty-six children (20 male, 16 female), who were diagnosed in the SHIP french centres (Société d'hématologie et d'immunologie pédiatrique) between 1990 and 2002 with ES, were included in this retrospective study.


RESULTS
Median age at diagnosis was 4 years. In 21 children, ES occurred in the setting of consanguinity, family history of autoimmune/inflammatory disease, associated autoimmune disorder or immunoregulatory abnormalities (serum imunoglobulins, peripheral blood lymphocytes subsets, low level of the C3-C4 complement components, nuclear antibodies). Several successive treatments were used in this serie (median: 3, range: 0-10) including corticosteroid therapy (35/36), intravenous immunoglobulins (32/36), immunosuppressive agents (14/36), splenectomy (9/36) and anti CD 20 monoclonal antibodies (6/36). Patients with a low level of serum immunoglobulins were more often non-responders to corticosteroidtherapy/intravenous immunoglobulins and required more frequently further therapy (P=0.03). Three patients died (intracranial bleeding, N=2, Guillain-Barre syndrome; N=1).


CONCLUSIONS
ES was a severe, life-threatening disease, requiring aggressive immunosuppressive therapy in as many as half the patients. Our forthcoming study aims to (i) describe homogeneously-studied and prospectively-analysed cohort of childhood ES, (ii) separate ES from specific immune deficiency (especially fas gene mutations), generalised autoimmune/inflammatory disorders and genetic diseases, (iii) identify well-defined ES subsets, (iv) establish prognostic factors and optimal treatment within these subsets.
Blouin
P
P
Service de pédiatrie, Hôtel-Dieu, BP 69, 63003 Clermont-Ferrand cedex, France. pblouin@chu-clermontferrand.fr
Auvrignon
A
A
Pagnier
A
A
Thuret
I
I
Antoni
G
G
Bader-Meunier
B
B
Le Deist
F
F
Chastagner
P
P
Aladjidi
N
N
Pellier
I
I
Bertrand
Y
Y
Behar
C
C
Landmann-Parker
J
J
Leverger
G
G
Perel
Y
Y
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017668:Age of Onset; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy / Q000235:genetics / Q000276:immunology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003241:Consanguinity; D005260:Female; D005602:France; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D008297:Male; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000235:genetics / Q000276:immunology / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous