title: Autoimmune cytopenias associated with inflammatory bowel diseases: Insights from a multicenter retrospective cohort.
abstract: BACKGROUND
  Autoimmune cytopenias (AIC) including autoimmune hemolytic anemia (AIHA) and immunologic thrombocytopenia (ITP) are rare immunologic disorders, scarcely reported in inflammatory bowel diseases (IBD). We conducted a multicentric retrospective study, including a case-control analysis, that aimed to describe the characteristics and outcomes of patients affected by AIC and IBD.
  
  
  METHODS
  Forty cases were recruited from 4 IBD centers and 2 AIC tertiary centers. Controls were recruited from the MICISTA registry.
  
  
  RESULTS
  From the MICISTA registry, incidences were estimated at 4.1/100,000 patient-years and 12.5/100,000 patient-years after IBD diagnosis for AIHA and ITP, respectively. All AIHA patients (n=14) had colonic involvement (13/14 with UC), whereas CD (52%) and UC (48%) diagnoses were evenly distributed among ITP patients. Compared to control IBD patients, cases were characterized by a higher frequency of extra-intestinal manifestations (37.5% vs 17%, p<0.001) and by the presence of IBD severity's hallmark. AIHA and IBD ran mainly in parallel, and 12 out of 14 AIHA were warm AIHA. In isolated cases, rituximab and infliximab were efficient to treat IBD and AIC, respectively. IBD surgery may induce AIC remission in some cases.
  
  
  CONCLUSIONS
  Although low, incidence of AIC appears higher in IBD patients compared to the general population. The association seems to be mainly non-fortuitous, especially for colitis-associated AIHA.
authors.affiliation: Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, AP-HP, University Paris 7 Denis Diderot, Clichy, France. Electronic address: mathieuuzzan@gmail.com.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Uzzan
authors.affiliation: Department of Clinical Immunology and EA3518, Saint-Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.affiliation: Department of Gastroenterology, Saint Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.affiliation: Department of Clinical Immunology and EA3518, Saint-Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Oksenhendler
authors.affiliation: Department of Clinical Immunology and EA3518, Saint-Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Fieschi
authors.affiliation: Department of Gastroenterology, Saint Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Allez
authors.affiliation: Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, AP-HP, University Paris 7 Denis Diderot, Clichy, France.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.affiliation: Department of Gastroenterology, Saint-Antoine Hospital, AP-HP, UPMC University Paris 6 Pierre et Marie Curie, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Kirchgesner
authors.affiliation: Department of Clinical Immunology and EA3518, Saint-Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Boutboul
authors.affiliation: Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, AP-HP, University Paris 7 Denis Diderot, Clichy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Treton
authors.affiliation: Department of Clinical Immunology and EA3518, Saint-Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Gérard
authors.affiliation: Department of Internal Medicine, Henri Mondor Hospital, AP-HP, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Mahévas
authors.affiliation: Department of Gastroenterology, Saint-Antoine Hospital, AP-HP, UPMC University Paris 6 Pierre et Marie Curie, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Department of Gastroenterology, Henri Mondor Hospital, AP-HP, EC2M3-Equipe Universitaire, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Amiot
mesh_terms: D000293:Adolescent; D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000453:epidemiology* / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000145:classification* / Q000150:complications* / Q000628:therapy*; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000069283:Rituximab; D000069285:Infliximab
keywords: Autoimmune cytopenias; Autoimmune hemolytic anemia; Crohn’s disease; Immunologic thrombocytopenia; Inflammatory bowel diseases; Ulcerative colitis