Venous thromboembolic events during warm autoimmune hemolytic anemia

Sylvain Audia, Benoit Bach, Maxime Samson, Daniela Lakomy, Jean-Baptiste Bour, Bénédicte Burlet, Julien Guy, Laurence Duvillard, Marine Branger, Vanessa Leguy-Seguin, Sabine Berthier, Marc Michel, Bernard Bonnotte, Sylvain Audia, Benoit Bach, Maxime Samson, Daniela Lakomy, Jean-Baptiste Bour, Bénédicte Burlet, Julien Guy, Laurence Duvillard, Marine Branger, Vanessa Leguy-Seguin, Sabine Berthier, Marc Michel, Bernard Bonnotte

Abstract

Thrombotic manifestations are a hallmark of many auto-immune diseases (AID), specially of warm autoimmune hemolytic anemia (wAIHA), as 15 to 33% of adults with wAIHA experience venous thromboembolic events (VTE). However, beyond the presence of positive antiphospholipid antibodies and splenectomy, risk factors for developing a VTE during wAIHA have not been clearly identified. The aim of this retrospective study was to characterize VTEs during wAIHA and to identify risk factors for VTE. Forty-eight patients with wAIHA were included, among whom 26 (54%) had secondary wAIHA. Eleven (23%) patients presented at least one VTE, that occurred during an active phase of the disease for 10/11 patients (90%). The frequency of VTE was not different between primary and secondary AIHA (23.7 vs. 19.2%; p = 0.5). The Padua prediction score based on traditional risk factors was not different between patients with and without VTE. On multivariate analysis, total bilirubin ≥ 40 μmol/L [odds ratio (OR) = 7.4; p = 0.02] and leucocyte count above 7x10(9)/L (OR = 15.7; p = 0.02) were significantly associated with a higher risk of thrombosis. Antiphospholipid antibodies were screened in 9 out the 11 patients who presented a VTE and were negative. Thus, the frequency of VTE is high (23%) during wAIHA and VTE preferentially occur within the first weeks of diagnosis. As no clinically relevant predictive factors of VTE could be identified, the systematic use of a prophylactic anticoagulation should be recommended in case of active hemolysis and its maintenance after hospital discharge should be considered. The benefit of a systematic screening for VTE and its procedure remain to be determined.

Trial registration: ClinicalTrials.gov NCT02158195.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart of patients.
Fig 1. Flowchart of patients.
Fig 2. Comparison of serum levels of…
Fig 2. Comparison of serum levels of soluble CD163, ferritin, free hemoglobin and nitrates between patients with venous thromboembolism (VTE+) and those without (VTE-).
Results are given by medians [interquartile range (IQR)]. NS: non-significant.

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