Finally, current therapeutic approaches for both TA-TMA and post-HSCT autoimmune HA, which are associated with high morbidity and mortality, are discussed. Failure of central and/or peripheral tolerance is believed to be involved in the escape of auto-reactive lymphocytes, thus leading, if uncontrolled, to the development of ADs. In addition, hypertension and proteinuria can be the early signs of TA-TMA, although these manifestations are encountered frequently in patients after HSCT.26,27,34,35 Soluble membrane attack complex (sC5b-9) may be elevated and is associated with a poor prognosis.30 Diagnosis can be confirmed by renal biopsy, which shows typical histologic findings, although there is little correlation between clinical and pathologic diagnosis. It is most important to observe the clinical symptoms of the recipient and stop the blood transfusion at the right moment. However, transfusion requirement in acute AIHA can be a medical emergency and must not be delayed as RBC transfusions can be lifesaving. This effect is largely attributed to the binding nitric oxide by free haemoglobin (NO) [36]. ATG indicates anti-thymocyte globulin; DLI, donor-lymphocyte infusion; EPO, erythropoietin; PLS, passenger lymphocyte syndrome; RBC, red blood cell; and TPE, plasma exchange. Delayed haemolytic transfusion reactions are well tolerated by most patients. Features of late hemolytic transfusion reaction and time of their occurrence [21]. 0000004992 00000 n However, clinicians should be aware that titer determination is not standardized and shows a wide intra-individual variability. The prevention of renal failure is aided by an early prevention of hypotension. MFk t,:.FW8c1L&9aX: rbl1 Clinically significant differences between the above mechanisms of red blood cells destruction are based on the time of onset of haemolysis and the destruction rate of red blood cells. By Osaro Erhabor, Tosan Erhabor, Teddy Charles Adias By Vivian Gonzaga, Bruna Policiquio, Cristiane Wences By Vernica Valdivieso-Gmez, Javier Garrancho-Prez, IntechOpen Limited The evaluation of haptoglobin and free hemoglobin in serum and urine can be helpful. Again, evidence is too weak to support treatment with TPE.14,41, Autoimmune diseases (ADs) after both autologous and allogeneic (including cord blood) HSCT may occur regardless of the underlying disease.42-44 The exact mechanisms and the pathophysiology of post-transplant ADs are not yet fully understood.
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