title: Plasma exchanges do not increase red blood cell transfusion efficiency in severe autoimmune hemolytic anemia: a retrospective case-control study.
abstract: Severe autoimmune hemolytic anemia (AIHA) can cause life-threatening hemolysis requiring red blood cell transfusions (RBT). The efficiency of RBT could be improved with the use of plasma exchanges (PEx) before RBT. The objective of this study was to assess the effectiveness of PEx in severe AIHA of adults. All adult patients with severe AIHA requiring RBT were included in this single center retrospective case-control study. The end point was change in hemoglobin (Hb) level after RBT, depending on whether PEx was done (experimental group) or not (control group). Thirty-one sessions of RBT following PEx were performed on the 5 patients of the experimental group and were compared with the 7 sessions of BT without PEx performed on the 4 patients of the control group. Despite a lower mean Hb value before the session of RBT (5.7 g/dl vs. 7.2 g/dl, P = 0.04) in the control group, the mean Hb value 5 (4-7) days following RBT (8.7 g/dl vs. 8.6 g/dl, P = 0.85) was not different in the experimental and in the control group, respectively. In a second analysis in which each patient was his own control (31 sessions of RBT following PEx vs. 51 sessions of RBT alone), the gain in Hb was not different (1.4 g/dl vs. 1.9 g/dl, P = 0.67). When RBT are required in severe AIHA of adults, the use of a single PEx before BT does not increase the efficiency of RBT based on day 5 evaluation.
authors.affiliation: Fédération de Médecine Interne et d'Hématologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, France. mruivard@chu-clermontferrand.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Ruivard
authors.forename: Olivier
authors.initials: O
authors.lastname: Tournilhac
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Montel
authors.forename: Alain-Charles
authors.initials: AC
authors.lastname: Fouilhoux
authors.forename: Fabienne
authors.initials: F
authors.lastname: Quainon
authors.forename: Alain
authors.initials: A
authors.lastname: Lénat
authors.forename: Philippe
authors.initials: P
authors.lastname: Travade
authors.forename: Pierre
authors.initials: P
authors.lastname: Philippe
mesh_terms: D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000628:therapy*; D016022:Case-Control Studies; D017707:Erythrocyte Transfusion / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D010956:Plasmapheresis / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D006454:Hemoglobins