Download - Brain CT / hemolytic anemia
![Page 1: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/1.jpg)
L E A R N I N G P O I N T S
MORNING REPORT 06/09
![Page 2: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/2.jpg)
WHAT IS THE DIAGNOSIS?
![Page 3: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/3.jpg)
CAROTID ARTERY STENOSIS
• Causes approximately 10 to 20% of strokes.• Occurs most frequently at its bifurcation.• Atherosclerotic plaques cause symptoms most
often through distal embolism to branches of the retinal or cerebral arteries (MCA).• 50% patients with symptomatic carotid disease
report TIA symptoms preceding the stroke.
Grotta JC. Carotid stenosis. N Engl J Med 2013;369:1143-1150
![Page 4: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/4.jpg)
TREATMENT
• In patients with symptomatic disease, carotid endarterectomy should be considered within 2 weeks if there is stenosis of more than 70% of the diameter of the ipsilateral carotid artery• Less benefit in patients with stenosis of 50 to 69% and in
asymptomatic patients, and there is no benefit in patients with stenosis of less than 50%.
• Carotid stenting is an alternative to carotid endarterectomy, particularly in patients at high surgical risk and in younger patients (<70 years of age).
Grotta JC. Carotid stenosis. N Engl J Med 2013;369:1143-1150
![Page 5: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/5.jpg)
LEARNING POINTS
![Page 6: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/6.jpg)
AUTOIMMUNE HEMOLYTIC ANEMIA
Lechner K, Jäger U (2010) How I treat autoimmune hemolytic anemias in adults. Blood 116(11):1831–8.
![Page 7: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/7.jpg)
AUTOIMMUNE HEMOLYTIC ANEMIA
Warm Ab
IgGReacts against protein Ag on
the RBC surface
Cold Ab
90% IgMReacts against polysaccharide
Ag
Mixed Ab
Swiecicki PL, Hegerova LT, Gertz MA. Cold agglutinin disease. Blood 2013;122:1114–21.
![Page 8: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/8.jpg)
COLD AGGLUTININ DISEASE
• 15% of patients with autoimmune hemolytic anemia. • Cold agglutinin IgM can be:• Monoclonal: underlying lymphoproliferative disorder• Polyclonal: post-infectious setting (mycoplasma, EBV,
legionella)
• The diagnosis is establish with hemolytic anemia, reticulocytosis, hyperbilirubinemia, ↑ LD, and + Coombs test for anti-C3 and classically negative anti-IgG.• After test findings suggest CAD, the antibody titer and thermal
activity should be determinedSwiecicki PL, Hegerova LT, Gertz MA. Cold agglutinin disease. Blood 2013;122:1114–21.
![Page 9: Brain CT / hemolytic anemia](https://reader036.vdocuments.site/reader036/viewer/2022062303/556dbb0bd8b42aed2e8b4aea/html5/thumbnails/9.jpg)
TREATMENT
• Nonpharmacologic measures are the cornerstone of management of CAD: avoiding cold exposure.
• Supportive transfusions may be used in patients with severe anemia. An in-line blood warmer should be considered to minimize cold agglutinin binding to transfused red cells.
• The most appropriate pharmacotherapy for CAD has remained an area of research. • 35% of patients treated with single-agent prednisone had a response, and most
responders needed further therapy. • Alkylating agent–containing regimens had a 44% response rate, but a similar low
proportion of patients achieved independence from further therapy compared with those being given corticosteroid-containing regimens.
• Response rate of 50% with purine analogs, with 40% of treated patients achieving independence from further therapy.
• Rituximab response rates were 83% in single-agent therapy and 79% in combination therapy with 51% patients achieving independence from further therapy.
Swiecicki PL, Hegerova LT, Gertz MA. Cold agglutinin disease. Blood 2013;122:1114–21.