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Hematology/oncology Clinics of North... Apr 2022The causes of hemolytic anemia are numerous and a systematic approach is critical for proper identification and classification. The direct antiglobulin test can... (Review)
Review
The causes of hemolytic anemia are numerous and a systematic approach is critical for proper identification and classification. The direct antiglobulin test can establish the diagnosis and subclassify the majority of autoimmune hemolytic anemias. Further testing to identify the driver of AIHA can have significant implications in overall management. Advanced testing for rare nonimmune acquired hemolytic anemias or hereditary hemolytic anemias may be necessary if DAT testing is negative.
Topics: Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Autoantibodies; Coombs Test; Diagnosis, Differential; Humans
PubMed: 35282951
DOI: 10.1016/j.hoc.2021.12.001 -
Blood Reviews May 2020Autoimmune hemolytic anemias (AIHAs) are rare and heterogeneous disorders characterized by the destruction of red blood cells through warm or cold antibodies. There is... (Review)
Review
Autoimmune hemolytic anemias (AIHAs) are rare and heterogeneous disorders characterized by the destruction of red blood cells through warm or cold antibodies. There is currently no licensed treatment for AIHA. Due to the paucity of clinical trials, recommendations on diagnosis and therapy have often been based on expert opinions and some national guidelines. Here we report the recommendations of the First International Consensus Group, who met with the aim to review currently available data and to provide standardized diagnostic criteria and therapeutic approaches as well as an overview of novel therapies. Exact diagnostic workup is important because symptoms, course of disease, and therapeutic management relate to the type of antibody involved. Monospecific direct antiglobulin test is considered mandatory in the diagnostic workup, and any causes of secondary AIHA have to be diagnosed. Corticosteroids remain first-line therapy for warm-AIHA, while the addition of rituximab should be considered early in severe cases and if no prompt response to steroids is achieved. Rituximab with or without bendamustine should be used in the first line for patients with cold agglutinin disease requiring therapy. We identified a need to establish an international AIHA network. Future recommendations should be based on prospective clinical trials whenever possible.
Topics: Adrenal Cortex Hormones; Adult; Anemia, Hemolytic, Autoimmune; Bendamustine Hydrochloride; Coombs Test; Disease Management; Humans; Rituximab
PubMed: 31839434
DOI: 10.1016/j.blre.2019.100648 -
Journal of the Neurological Sciences Jan 2021Brucellosis is a common Zoonosis affecting half a million people annually. The most common mode of infection is by consuming unpasteurized milk or milk products. The...
Brucellosis is a common Zoonosis affecting half a million people annually. The most common mode of infection is by consuming unpasteurized milk or milk products. The general manifestations are those of fever with generalized symptoms. The nervous system is affected in 4-7% of cases. The manifestations are protean and include meningo-encephalitis as well as peripheral nervous system involvement. The diagnosis relies on culture, which is cumbersome and can be falsely negative. Agglutination tests for the various species of the organism are the mainstay for diagnosis. Treatment is for 3-6 months with combination therapy including Doxycycline, Rifampicin and ceftriaxone. The main issue is prevention and better animal husbandry.
Topics: Agglutination Tests; Animals; Brucellosis; Doxycycline; Fever; Rifampin
PubMed: 33358192
DOI: 10.1016/j.jns.2020.117280 -
The Veterinary Clinics of North... Jul 2019Several diagnostic tests are available to aid veterinarians in diagnosis of leptospirosis. Understanding the course of infection is imperative to determining which... (Review)
Review
Several diagnostic tests are available to aid veterinarians in diagnosis of leptospirosis. Understanding the course of infection is imperative to determining which diagnostic test to order and sample to submit. Diagnostic tests for dogs suspected of having leptospirosis include antibody-based tests and polymerase chain reaction (PCR). Paired acute and convalescent microscopic agglutination test (MAT) are diagnostic for leptospirosis. PCR performed on blood and/or urine can be a valuable tool to aid in diagnosis of leptospirosis. Commercially available rapid point-of-care diagnostics have been validated in dogs and have value early in the course of illness before MAT and PCR results are available.
Topics: Animals; Dog Diseases; Dogs; Enzyme-Linked Immunosorbent Assay; Genotype; Leptospira; Leptospirosis
PubMed: 30961998
DOI: 10.1016/j.cvsm.2019.02.008 -
BMJ (Clinical Research Ed.) Jun 2019
Topics: Agglutination Tests; Anti-Bacterial Agents; Chancre; Disease Transmission, Infectious; Female; Humans; Incidence; Luminescent Measurements; Male; Sexually Transmitted Diseases, Bacterial; Syphilis; Syphilis Serodiagnosis; Treponema pallidum
PubMed: 31253629
DOI: 10.1136/bmj.l4159 -
Mikrobiyoloji Bulteni Jan 2023Syphilis is a sexually transmitted disease caused by Treponema pallidum subsp. pallidum. This historical disease has diverse clinical manifestations making laboratory... (Review)
Review
Syphilis is a sexually transmitted disease caused by Treponema pallidum subsp. pallidum. This historical disease has diverse clinical manifestations making laboratory testing crucial for optimal patient management. Direct detection of T.pallidum by dark-field microscopy is possible when lesions are present. Culture of the bacteria is complex and not performed routinely. There is no well-validated commercially available polymerase chain reaction (PCR) test. Serological tests are currently the most common diagnostic methods adapted in clinical laboratories. They provide a presumptive diagnosis and used for screening, diagnosis, and follow-up of the treatment. They are divided into two groups, named as nontreponemal and treponemal tests and performed by the application of the traditional algorithm, the reverse sequence algorithm or European Centre for Disease Prevention and Control (ECDC) algorithm. The traditional algorithm starts with a nontreponemal test and a reactive result is confirmed with a treponemal test. In the reverse sequence algorithm, a treponemal test is used for screening and a reactive result is confirmed by a quantitative nontreponemal test. When the nontreponemal test is negative, a second different treponemal test preferably T.pallidum particle agglutination test (TPPA) is used. The ECDC algorithm recommends screening by a treponemal test such as T.pallidum enzym immunoassay (TP-EIA), T.pallidum chemiluminescence immunoassay (CIA) and if reactive, a reflex confirmatory treponemal test is performed. The treponemal tests become reactive a few weeks after infection and remain reactive even after successful treatment. The nontreponemal tests are used to assess disease activity and response to therapy. Serological tests have many limitations such as false-positivity, falsenegativity in various stages of the disease and also challenging difficulties when evaluating response to therapy. In recent years, rapid syphilis tests which are mostly treponemal-specific tests have been developed for high-prevalence populations in resource limited settings. There has been requirement for the utility of standart PCR and IgM testing in the diagnosis of congenital syphilis and neurosyphilis cases. In this review article, it was aimed to present the diagnostic tests, the algorithms, the correct indications for testing and interpretation of the test results to the likely corresponding clinical stage of the disease with in the perspective of recent advances.
Topics: Humans; Syphilis; Mass Screening; Treponema pallidum; Syphilis Serodiagnosis; Clinical Laboratory Techniques; Algorithms; Antibodies, Bacterial
PubMed: 36636853
DOI: 10.5578/mb.20239912 -
Hematology/oncology Clinics of North... Apr 2022Hematologists often rely on the results of a positive direct antiglobulin test to confirm a diagnosis of autoimmune hemolytic anemia, but immune hemolytic anemia can... (Review)
Review
Hematologists often rely on the results of a positive direct antiglobulin test to confirm a diagnosis of autoimmune hemolytic anemia, but immune hemolytic anemia can occur when no immunoglobulin is detectable by routine methods. Negative DATs in these patients may be due to a small quantity of IgG on their red blood cells (RBCs) (below detectable levels), or when low-affinity anti-IgG is present, or when the autoantibodies are IgA or IgM in nature. A panel of tests developed to detect immunoglobulins on these patients' RBCs may be performed in a few specialized laboratories. These tests can be helpful in instances whereby the clinical picture of AIHA seems obvious, but the laboratory values are misleading.
Topics: Anemia, Hemolytic; Anemia, Hemolytic, Autoimmune; Autoantibodies; Coombs Test; Erythrocytes; Humans
PubMed: 35282952
DOI: 10.1016/j.hoc.2021.11.004 -
Comparative Immunology, Microbiology... Feb 2022Canine parvovirus (CPV) is a major cause of hemorrhagic diarrhea and mortality in puppies worldwide. There are 2 types of Parvovirus which affects canines: Canine... (Review)
Review
Canine parvovirus (CPV) is a major cause of hemorrhagic diarrhea and mortality in puppies worldwide. There are 2 types of Parvovirus which affects canines: Canine parvovirus 2 (CPV-2) and Canine parvovirus 1 (CPV-1) or the Minute Virus of Canine (MVC). CPV-2 originated from Feline panleukopenia virus and has undergone genetic variation to give rise to its three variants (CPV-2a, CPV-2b and CPV-2c). Amino acid substitutions in VP2 capsid protein have led virus to adapt new host range. The original CPV-2 was known to be dominant in Japan, Belgium, Australia as well as USA and later circulated throughout the world. Clinically, CPV-2 infection is characterized by anorexia, lethargy, depression, vomiting, leukopenia and severe hemorrhagic diarrhea. Several diagnostic tests have been developed to detect parvoviral infections which are categorized into immunological tests (latex agglutination test, SIT-SAT and ELISA etc.) and molecular based tests (PCR, mPCR and RT-PCR etc.). To control and manage the disease several treatments like fluid therapies, antibiotics, and adjunctive treatments are available and some are in various stages of development. Apart from this, many vaccines are also commercially available and some are in developmental stages. The present review contains detailed information regarding structural biology, occurrence, pathogenesis, clinical diagnosis, treatments and prevention in order to understand the need and the growing importance of CPV-2.
PubMed: 35182832
DOI: 10.1016/j.cimid.2022.101765 -
Journal of Perinatology : Official... Feb 2023The diagnosis of ABO hemolytic disease of the newborn (ABO HDN) has been the subject of considerable debate and clinical confusion. Its use as an overarching default... (Review)
Review
The diagnosis of ABO hemolytic disease of the newborn (ABO HDN) has been the subject of considerable debate and clinical confusion. Its use as an overarching default diagnosis for hyperbilirubinemia in all ABO incompatible neonates regardless of serological findings is problematic and lacks diagnostic precision. Data on hemolysis indexed by carbon monoxide (CO) levels in expired air (ETCOc) and blood (COHbc) support an essential role for a positive direct antiglobulin test (DAT) in making a more precise diagnosis of ABO HDN. A working definition that includes ABO incompatibility, significant neonatal hyperbilirubinemia, and a positive DAT is needed to gain clarity and consistency in the diagnosis of ABO HDN. Absent a positive DAT, the diagnosis of ABO HDN is suspect. Instead, a negative DAT in a severely hyperbilirubinemic ABO incompatible neonate should trigger an exhaustive search for an alternative cause, a search that may require the use of targeted gene panels.
Topics: Infant, Newborn; Female; Humans; ABO Blood-Group System; Erythroblastosis, Fetal; Blood Group Incompatibility; Hyperbilirubinemia, Neonatal; Hemolysis; Coombs Test
PubMed: 36344813
DOI: 10.1038/s41372-022-01556-6