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Infection and immunology
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
5.13. Which of the following statements is/are true of Mycoplasma pneumoniae respiratory tract infections in children?They are diagnosed by demonstrating cold agglutinins in the blood.They are a most common cause of pneumonia in school age children.The organism is easily grown from sputum cultures.The infections are associated with middle ear disease.They are treated with erythromycin.
Mycoplasma Pneumoniae Pneumonia *
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Cold hemagglutinin titers of 1:64 or greater, along with the above-described clinical presentation, support the diagnosis. The rise in titer generally begins during the second week of the illness. Cold agglutinins may not be detected in the sera of patients with a mild illness and may be present in patients with viral infections. The diagnosis is confirmed by isolation of the organism and demonstration of specific antibody rise during the convalescent phase (10 days to 3 weeks after onset).
Evaluation of the Immune System
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Moira Thomas, Elizabeth Drewe, Richard J. Powell
Cryoglobulins are immunoglobulins that form gels or precipitates on cooling. Clinical features include purpura, Raynaud’s syndrome, thrombosis, neuropathy and vasculitis. They are associated with infections, connective tissue disease and lymphoproliferative disease. Detection relies on the appropriate collection into a prewarmed blood tube in a waterbath/vacuum flask. Cold agglutinins are autoantibodies that reversibly agglutinate erythrocytes in the cold and should not be confused with cryoglobulins.
Monoclonal antibodies for treatment of cold agglutinin disease
Published in Expert Opinion on Biological Therapy, 2023
Georg Gelbenegger, Sigbjørn Berentsen, Bernd Jilma
The safety and efficacy of eculizumab in patients with CAD was evaluated in a prospective, open-label, bicentric, nonrandomized phase II trial [21] (Table 3, Supplementary Table S2). Patients were eligible for inclusion if they were 18 years of age or older, required treatment because of CAD-related symptoms or had transfusion dependency, and had LDH levels that were at least double the upper limit of normal. Cold agglutinin disease was defined as chronic hemolysis, a cold agglutinin titer of 64 or more at 4°C, and a DAT strongly positive for C3d but negative or only weakly positive for IgG. Key exclusion criteria were treatment with rituximab, alkylating agents, human immunoglobulins, or plasmapheresis at least four weeks before screening. Patients were vaccinated for Neisseria meningitidis before receiving complement inhibition treatment. Included patients received treatment with eculizumab 600 mg weekly for four weeks, followed one week later by eculizumab 900 mg every other week through week 26. The primary endpoint was the difference in LDH level between the first and the last day of eculizumab treatment. The trial included 13 CAD patients. Eleven patients completed the 26-week treatment phase and received all 16 scheduled eculizumab infusions. Eculizumab significantly reduced LDH levels from 572 U/L to 334 U/L (p = 0.0215) but did not significantly increase hemoglobin levels. Despite failure to increase hemoglobin levels, eight patients achieved transfusion independency. Eculizumab was well tolerated, and no meningococcal infections occurred.
Healthcare resource utilization among patients with cold agglutinin disease in Denmark
Published in Current Medical Research and Opinion, 2021
Emese K. Vágó, Gina Nicholson, Erzsébet Horváth-Puhó, Naushin Hooda, Jon P. Fryzek, Jun Su
Cold agglutinin disease (CAD), a rare subtype of autoimmune hemolytic anemia, affects an estimated 16 per 1 million individuals, with a median survival of 8.5–12.5 years after disease onset in European cohorts1,2. CAD is mediated by monoclonal immunoglobulin M autoantibodies, called cold agglutinins, which bind to the I antigen on the surface of red blood cells3. Cold agglutinins are most pathogenic when their thermal amplitude (the highest temperature at which they bind to red blood cell antigens) overlaps with vascular temperatures at the lower limit of normal4. When bound to red blood cells, cold agglutinins activate complement component 1 (C1 complex) and trigger the classical complement pathway, resulting in extravascular hemolysis and, to a lesser extent, intravascular hemolysis3,5,6.
Transitioning Select Chemotherapeutics to the Outpatient Setting Improves Care and Reduces Costs
Published in Oncology Issues, 2021
Since 2015 when we transitioned certain rituximab administrations to the outpatient setting, we decreased our inpatient bed stays, reduced our inpatient chemotherapy costs, and increased the use of our own specialty pharmacy for patients receiving intravenous rituximab combination regimens, as well as an increased use of this model post-implementation for standard order sets. However, not every patient receiving rituximab can be treated in the outpatient setting. Accordingly, we have developed patient restrictions for rituximab in the outpatient setting, including:Immune thrombocytopenic purpura—dose-reduced rituximab, 100 mg9.Cold agglutinin disease.Post-transplant lymphoproliferative disease.Autoimmune hemolytic anemia.Prolonged chemotherapy inpatient stays requiring continued treatment.Infusion reaction or need for rituximab desensitization.