Seasonal Variation of Immune Hemolytic Anemia

Yıl 2021, , 36 - 41, 23.04.2021

Demircan Özbalcı , Emine Güçhan Alanoğlu , Ruveyda Sak

https://doi.org/10.30565/medalanya.804346

Öz

Aim: Immune hemolytic anemia is an autoimmune disease that is related to autoantibodies against erythrocytes. Such antibodies appear for a variety of reasons such as hematologic and oncologic malignancies, infections, and connective tissue diseases but in many cases, a true etiologic agent has not been discovered. Many hematologic, as well as rheumatologic disorders, have seasonal variations but there have not been many studies evaluating the possibility of seasonal variation of immune hemolytic anemia.

Methods: It was investigated whether the patients with immune hemolytic anemia who were diagnosed and followed in the hematology outpatient and inpatient clinic of Suleyman Demirel University from 2002 to 2018 had a significant seasonality. We also evaluated whether there was any seasonality relationship between gender and beginning of the hemolytic attacks.

Results: There was no significant difference when seasons were grouped as spring, summer, autumn and winter, according to gender (p = 0,122). The evaluation of seasons in two groups as autumn-winter and spring-Summer revealed that male patients tended to suffer immune hemolytic anemia in autumn-winter, whereas females, significantly, tend to contract the disease in spring-Summer (p=0,046).

Conclusion: Immune hemolytic anemia had significant seasonality pattern depending on gender. More prospective studies are needed to support these findings in this study.

Anahtar Kelimeler

immune hemolytic anemia, seasonality, gender

İmmün Hemolitik Aneminin Mevsimsel Değişkenliği

Öz

Amaç: İmmün hemolitik anemi, eritrositlerle ilişkili otoantikorlara bağlı otoimmün bir hastalıktır. Bu tür antikorlar, hematolojik ve onkolojik maligniteler, enfeksiyonlar ve bağ dokusu hastalıkları gibi çeşitli nedenlerle ortaya çıkar ancak, bazı durumlarda, etyolojik faktör tespit edilememektedir. Hematolojik ve romatolojik bozuklukların birçoğunun mevsimsel varyasyonları vardır, ancak immün hemolitik aneminin mevsimsel değişim olasılığını değerlendiren çok fazla çalışma yoktur.

Metot: 2002-2018 yılları arasında Süleyman Demirel Üniversitesi hematoloji polikliniğinde ve yatarak tedavi kliniğinde tanı ve takibi yapılan immün hemolitik anemili hastaların anlamlı mevsimselliğe sahip olup olmadığı araştırıldı. Ayrıca, immün hemolitik anemi atağının başlangıcı ile cinsiyetler arasında mevsimsellik ilişkisi olup olmadığı araştırıldı.

Bulgular: Cinsiyete göre mevsimler ilkbahar, yaz, sonbahar ve kış olarak gruplandırıldığında anlamlı fark yoktu (p = 0,122). Mevsimleri sonbahar-kış ve ilkbahar-yaz olarak iki grupta değerlendirdiğimizde, erkek hastaların sonbahar-kış aylarında immün hemolitik anemiye eğilimli olduklarını, kadınların ise ilkbahar-yaz aylarında önemli ölçüde hastalığa yakalanma eğiliminde olduklarını bulduk.

Sonuç: İmmün hemolitik aneminin, cinsiyete bağlı olarak, istatistiksel olarak anlamlı mevsimsellik paterni olduğunu gösterdik. Bu çalışmadaki bulguları desteklemek için daha fazla prospektif çalışmaya ihtiyaç vardır. 

Anahtar Kelimeler

immün hemolitik anemi, mevsimsellik, cinsiyet

Kaynakça

• 1- Liebmann HA, Wietz IC. Autoimmune hemolytic anemia. Med Clin N Am 2017;101(2):351–9 doi: 10.1016/j.mcna.2016.09.007.
• 2- Quist E, Koepsell S. Autoimmune Hemolytic Anemia and Red Blood Cell Autoantibodies. Arch Pathol Lab Med. 2015;139(11):1455-8. doi: 10.5858/arpa.2014-0337-RS.
• 3- Naik R. Warm autoimmune hemolytic anemia. Hematol Oncol Clin North Am. 2015;29(3):445-53. doi: 10.1016/j.hoc.2015.01.001. 4- Shulman IA, Branch DR, Nelson JM, Thompson JC, Saxena S, Petz LD. Autoimmune hemolytic anemia with both cold and warm autoantibodies. JAMA. 1985;253(12):1746-8. PMID: 3974053.
• 5- Shanbhag S, Spivak J. Paroxysmal cold hemoglobinuria. Hematol Oncol Clin North Am. 2015;29(3):473-8. doi: 10.1016/j.hoc.2015.01.004.
• 6- Kalfa TA. Warm antibody autoimmune hemolytic anemia. Hematology Am Soc Hematol Educ Program. 2016;2016(1):690-7. doi: 10.1182/asheducation-2016.1.690.
• 7- Karimi M, Yarmohammadi H. Seasonal variations in the onset of childhood leukemia/lymphoma: April 1996 to March 2000, Shiraz, Iran. Hematol Oncol. 2003;21(2):51-5. doi: 10.1002/hon.702.
• 8- Calip GS, McDougall JA, Wheldon MC, Li CI, De Roos AJ. Evaluation of seasonality in the diagnosis of acute myeloid leukaemia among adults in the United States, 1992-2008. Br J Haematol. 2013;160(3):343-50. doi: 10.1111/bjh.12137.
• 9- Borchmann S, Müller H, Engert A. Hodgkin Lymphoma has a seasonal pattern of incidence and mortality that depends on latitude. Sci Rep. 2017;7(1):14903. doi: 10.1038/s41598-017-14805-y.
• 10- Raval JS, Harm SK, Rollins-Raval MA, Kiss JE. Seasonal distribution of severe ADAMTS13 deficient idiopathic thrombotic thrombocytopenic purpura. J Clin Apher. 2014;29(2):113-9. doi: 10.1002/jca.21300.
• 11- Park YA, Poisson JL, McBee MT, Afenyi-Annan A. Seasonal association of thrombotic thrombocytopenic purpura. Transfusion. 2012;52(7):1530-4. doi: 10.1111/j.1537-2995.2011.03481.x.
• 12- Tombak A, Boztepe B, Tiftik N, Cömert M, Salim O, Aydın K, et al. Seasonal Association of Immune Thrombocytopenia in Adults. Balkan Med J. 2015;32(4):347-51. doi: 10.5152/balkanmedj.2015.151223.
• 13- Moulis G, Guénin S, Limal N, Michel M, Bierling P, Godeau B, et al. Seasonal variations of incident primary immune thrombocytopenia in adults: An ecological study. Eur J Intern Med. 2017;37: e26-e28. doi: 10.1016/j.ejim.2016.09.025.
• 14- Giri S, Pathak R, Aryal MR, Karmacharya P, Bhatt VR, Martin MG. Seasonal variation of immune thrombocytopenic purpura related hospitalizations among adults in the USA: analysis of the nationwide inpatient sample database. Ther Adv Hematol. 2015;6(4):217-8. doi: 10.1177/2040620715582146.
• 15- Guntupalli S, Patel D, Soni RGK, Devarashetty S, Mansour RP. Seasonal Variation in Autoimmune Hemolytic Anemia: A National Database Analysis. Blood 2018;132 (Suppl. 1):4883. doi: 10.1182/blood-2018-99-113882.
• 16- Vom Steeg LG, Klein SL. SeXX Matters in Infectious Disease Pathogenesis. PLoS Pathog. 2016;12(2): e1005374. doi: 10.1371/journal.ppat.1005374.
• 17- Morgan R, Klein SL. The intersection of sex and gender in the treatment of influenza. Curr Opin Virol. 2019;35:35-41. doi: 10.1016/j.coviro.2019.02.009.
• 18- Boctor FN, Charmy RA, Cooper EL. Seasonal differences in the rhythmicity of human male and female lymphocyte blastogenic responses. Immunol Invest. 1989;18(6):775-84. doi: 10.3109/08820138909030598.
• 19- Rodríguez-de la Cruz D, Sánchez-Reyes E, Dávila-González I, Lorente-Toledano F, Sánchez-Sánchez J. Airborne pollen calendar of Salamanca, Spain, 2000-2007. Allergol Immunopathol (Madr). 2010;38(6):307-12. doi: 10.1016/j.aller.2010.04.001.
• 20- Pedullá M, Fierro V, Papacciuolo V, Alfano R, Ruocco E. Atopy as a risk factor for thyroid autoimmunity in children affected with atopic dermatitis. J Eur Acad Dermatol Venereol. 2014;28(8):1057-60. doi: 10.1111/jdv.12281.
• 21- Duarte-García A, Fang H, To CH, Magder LS, Petri M. Seasonal variation in the activity of systemic lupus erythematosus. J Rheumatol. 2012;39(7):1392-8. doi: 10.3899/jrheum.111196.
• 22- Hasan T, Pertovaara M, Yli-Kerttula U, Luukkaala T, Korpela M. Seasonal variation of disease activity of systemic lupus erythematosus in Finland: a 1 year follow up study. Ann Rheum Dis. 2004;63(11):1498-500. doi: 10.1136/ard.2003.012740.