Patrick Daly

DocwireNews

Administration of C1 esterase inhibitor (C1-INH) during transfusions &ldquo;temporarily reduced complement activation,&rdquo; but did not significantly suppress hemolytic activity among patients with severe transfusion-dependent, complement-mediated autoimmune hemolytic <a href="https://www.docwirenews.com/page/anemia">anemia</a> (CM-AIHA), according to a report in Blood Advances.&ldquo;Peritransfusional C1-INH temporarily reduced complement activation,&rdquo; summarized the study&rsquo;s lead author, Esther de Boer, MD, PhD, from Amsterdam Infection and Immunity Institute in the Netherlands. &ldquo;However, C1-INH failed to halt hemolytic activity in severe transfusion-dependent-CM-AIHA.&rdquo;The prospective, single-center, <a href="https://ashpublications.org/bloodadvances/article/7/13/3128/494907/C1-inhibitor-treatment-in-patients-with-severe" target="_blank" rel="noopener">phase II trial</a> enrolled 10 patients with confirmed CM-AIHA who were indicated for transfusion of two units of red blood cells (RBCs). Participants received four doses of intravenous C1-INH at 12-hour intervals around transfusion. Blood samples were taken and evaluated for <a href="https://www.docwirenews.com/post/add-on-factor-d-inhibitor-improves-hemoglobin-levels-in-pnh-with-hemolysis">hemolytic activity</a>, RBC opsonization, complement activation, and markers of inflammation.Transfusions Not Significantly Improved with C1-inhibitor Reportedly, patients showed increased plasma C1-INH antigen and activity that peaked at 48 hours after administration, as well as a significant reduction of C3d deposition on RBCs. Hemoglobin levels briefly increased after transfusion but returned to baseline within 48 hours. Five grade 3 and one grade 4 adverse events occurred that were judged unrelated to the peritransfusional C1-INH.The authors judged that markers of hemolysis, complement activation, and inflammation did not change overall, though they added that they could not exclude that post-transfusional hemolytic activity would have been higher without C1-INH administration.&ldquo;In conclusion, these data do not support the clinical use of C1-INH in the tested dose in patients with severe CM-AIHA but add to the increasing experience with proximal complement inhibitors in this patient population,&rdquo; Dr. de Boer and colleagues concluded.&nbsp;Referencede Boer ECW, Jalink M, Delvasto-Nu&ntilde;ez L, et al. C1-inhibitor treatment in patients with severe complement-mediated autoimmune hemolytic anemia. Blood Adv. 2023;7(13):3128-3139. doi:10.1182/bloodadvances.2022009402

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Can C1-inhibitor Improve Transfusion in Autoimmune Hemolytic Anemia?

Anemia

C1-inhibitor administration during transfusions did not significantly suppress hemolysis in patients with complement-mediated autoimmune hemolytic anemia.

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