Hbibi Mohamed, El Alaoui El Hanafi Mounira, Kasmi Zakaria, Ouair Hind, Benmiloud Sarra, Ailal Fatima, Hida Moustapha, Bousfiha Ahmed Aziz
Department of hematology-Oncology pediatric SHOP, Hassan II University Hospital, Fez, Morocco.
Department of hematology-Oncology pediatric SHOP, Ibn Rochd University Hospital, Casablanca, Morocco.
Tunis Med. 2024 Jan 5;102(1):1-6. doi: 10.62438/tunismed.v102i1.4503.
Autoimmune cytopenias are defined by autoantibodies' immune destruction of one or more blood elements. Most often it is autoimmune hemolytic anemia or immune thrombocytopenia or both that define Evans syndrome. It may be secondary to infection or to underlying pathology such as systemic autoimmune disease or primary immunodeficiency, especially when it becomes chronic over several years. Primary Immunodeficiencies or inborn errors of immunity (IEI) are no longer defined solely by infections: autoimmunity is part of the clinical features of several of these diseases. It is dominated by autoimmune cytopenias, in particular, immune thrombocytopenia (ITP) and autoimmune hemolytic anaemia (AIHA). The challenges for the clinician are the situations where autoimmune cytopenias are chronic, recurrent and/or refractory to the various long-term therapeutic options. Most of these therapies are similar in action and generally consist of non-mediated immune suppression or modulation. In these situations, primary Immunodeficiencies must be diagnosed as soon as possible to allow the initiation of a targeted treatment and to avoid several ineffective therapeutic lines.
自身免疫性血细胞减少症是由自身抗体对一种或多种血液成分的免疫破坏所定义的。最常见的是自身免疫性溶血性贫血或免疫性血小板减少症,或两者兼具,这就定义了伊文氏综合征。它可能继发于感染或潜在的病理状况,如系统性自身免疫性疾病或原发性免疫缺陷,尤其是当它持续数年变为慢性时。原发性免疫缺陷或遗传性免疫缺陷(IEI)不再仅由感染来定义:自身免疫是其中几种疾病临床特征的一部分。它以自身免疫性血细胞减少症为主,特别是免疫性血小板减少症(ITP)和自身免疫性溶血性贫血(AIHA)。临床医生面临的挑战是自身免疫性血细胞减少症呈慢性、复发性和/或对各种长期治疗方案难治的情况。这些治疗大多作用相似,通常包括非介导的免疫抑制或调节。在这些情况下,必须尽快诊断出原发性免疫缺陷,以便开始有针对性的治疗,并避免多种无效的治疗方法。