Anemia immunoglobulin

The answer is a. (Katzung, p 162.) Many drugs can cause an immunohemolytic anemia. Methyldopa may cause a positive Coombs test in as many as 20% of patients, along with hemolytic anemia. Other drugs with similar actions on red blood cells are penicillins, quinidine, procainamide, and sulfonamides. These form a stable or unstable hapten on the red cell surface, which induces an immune reaction I immunoglobulin G (IgG) antibodies] and leads to dissolution of the membrane. 

There is a generalized increase of all the immunoglobulins in helminth infections. In Nigeria I have observed high IgG levels and IgA in some patients with hookworm anemia. The IgM appeared to be normal in some of the sera tested, although there was one patient with values showing a 5-fold increase of serum IgM concentrations. 

Immunoglobulin obtained from pooled plasma obtained from hepatitis B and HIV negative donors is used as an aspecific immunostimulant in immunodeficiency diseases, idiopathic thrombocytopenia, autoimmune hemolytic anemias, Kawasaki syndrome and to prevent infections in immune compromised patients with leukemia or multiple myeloma. Adverse effects include potentially severe hypersensitivity reactions. 

Benzene is such a chemical that damages the bone marrow, and aplastic anemia results. This has several effects, one of which is a reduction in the lymphocyte as well as red cell population and so pancytopenia and therefore immunosuppression results. This leads to an increased susceptibility to infection and inhibited immunoglobulin production. These effects have been detected in both experimental animals and humans occupationally exposed to benzene. Thus, shoe workers in Turkey and China have been found to suffer aplastic anemia. 

This plasma cell malignancy is one of the models of neoplastic disease in humans because it arises from a single tumor stem cell, and the tumor cells produce a marker protein (myeloma immunoglobulin) that allows the total body burden of tumor cells to be quantified. Multiple myeloma principally involves the bone marrow and the surrounding bone, causing bone pain, lytic lesions, bone fractures, and anemia as well as an increased susceptibility to infection. 

As to cryoglobulins, both type I (single component or 1 isotype or subclass of immunoglobulin, or, rarely, a monoclonal light chain) and type II (mixed cryoglobulins with monoclonal IgM as antibody and IgG as antigen) may be present. Nearly 10% of all WM molecules are cryoprecipitable (Kl). Infiltration of bone marrow by tumor cells can result in severe anemia. 

In addition to cancer, too little apoptosis can also result in diseases such as autoimmune lymphoproliferative syndrome (ALPS). This occurs when there is insufficient apoptosis of auto-aggressive T cells, resulting in multiple autoimmune diseases. An overproliferation of B cells occurs as well, resulting in excess immunoglobulin production, leading to autoimmunity. Some of the common diseases of ALPS include hemolytic anemia, immune-mediated thrombocytopenia, and autoimmune neutropenia. The different types of this condition are caused by different mutations. Type 1A results from a mutation in the death domain of the Fas receptor, Type IB results from a mutation in Fas ligand, and Type 2 results from a mutation in caspase 10, reducing its activity. 

A 33-year-old woman with Evans syndrome received intravenous immunoglobulin 400 mg/kg/day and developed a deep vein thrombosis after 1 week (47). She was treated with warfarin, and 6 months later received an additional course of intravenous immunoglobulin for recurrent hemolytic anemia 1 day later she died of pulmonary thromboembolism. 

Severe acute hemolysis due to acquisition of red cell alloantibodies from donor serum has been reported (67-69). In other cases, the suggested mechanism of hemolytic anemia after high dosages of intravenous immunoglobulin was the presence of anti-A and/or anti-B antibodies in the plasma product (70). 

Nakagawa M, Watanabe N, Okuno M, Kondo M, Okagawa H, Taga T. Severe hemolytic anemia following high-dose intravenous immunoglobulin administration in a patient with Kawasaki disease. Am J Hematol 2000 63(3) 160-1. 

A 26-year-old woman with a diffuse large B cell lymphoma received CHOP (cyclophosphamide, hydroxy-daunomycin, Oncovin, and prednisone), ritnximab, and radiotherapy (14). She developed a transfnsion-dependent anemia. Bone marrow biopsy confirmed pure red cell aplasia and parvovirus infection. She had no antibodies to parvovirus, suggesting that she never had a previous exposure. Intravenous immunoglobulin resulted in a reticulocytosis and recovery of her hemoglobin. 

How does this suppression of normal immunoglobulin synthesis occur Simple displacement of the normal plasma cells by neoplastic cells seems unlikely, because in the marrow this would also result in leukoerythro-blastic anemia this in fact is found in fewer than 5% of these patients. Marrow occupation would also depress IgG first (Section 4.3), whereas this is usually the last to fall. Furthermore, IgA is largely derived from the gut, which is rarely directly involved by tumor. It has also been suggested that the neoplastic cells misappropriate available amino acids at the expense of normal plasma cells. Immunoglobulin deficiency is, however, unusual with most other types of neoplasia, and even among the... 

Colby C, Stoukides CA, Spitzer TR. Antithymocyte immunoglobulin in severe aplastic anemia and bone marrow transplantation. Ann Pharma-cother 1996 30 1164-1174. 

Lymphocyte immune globulin, an immunoglobulin with inununosuppressive properties (15 mg/kg/day IV for 14 days), is used in the prevention or treatment of acute renal allograft rejection, in aplastic anemia, skin allotransplantation, and in bone marrow allotransplantation (see also Figure 28). 

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