Giannotta Juri Alessandro, Fattizzo Bruno, Cavallaro Francesca, Barcellini Wilma
Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy.
Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy.
J Clin Med. 2021 Jan 5;10(1):164. doi: 10.3390/jcm10010164.
Autoimmune hemolytic anemia (AIHA) may be frequently challenged by infectious complications, mainly as a result of immunosuppressive treatments administered. Furthermore, infectious agents are known triggers of AIHA onset and relapse. Although being risk factors for mortality, infections are an underestimated issue in AIHA. This review will collect the available evidence on the frequency and type of infectious complications in AIHA, detailing the risk related to each treatment (i.e., steroids, rituximab, splenectomy, classic immunosuppressive agents, and new target drugs). Moreover, we will briefly discuss the infectious complications in AIHA secondary to other diseases that harbor an intrinsic infectious risk (e.g., primary immunodeficiencies, systemic autoimmune diseases, lymphoproliferative disorders, solid organ and hematopoietic stem cell transplants). Finally, viral and bacterial reactivations during immune suppressive therapies will be discussed, along with suggested screening and prophylactic strategies.
自身免疫性溶血性贫血(AIHA)常面临感染并发症的挑战,主要是由于所进行的免疫抑制治疗。此外,感染因子是已知的AIHA发病和复发的触发因素。尽管感染是死亡的危险因素,但在AIHA中却是一个被低估的问题。本综述将收集关于AIHA感染并发症的频率和类型的现有证据,详细阐述与每种治疗方法(即类固醇、利妥昔单抗、脾切除术、经典免疫抑制剂和新的靶向药物)相关的风险。此外,我们将简要讨论继发于其他存在内在感染风险的疾病(如原发性免疫缺陷、系统性自身免疫性疾病、淋巴增殖性疾病、实体器官和造血干细胞移植)的AIHA中的感染并发症。最后,将讨论免疫抑制治疗期间的病毒和细菌再激活,以及建议的筛查和预防策略。