Researchers discovered that baseline fluorescent antinuclear antibody (FANA) positivity among patients with autoimmune hemolytic anemia (AIHA) was associated with lower complete response rates and higher rates of relapse, as published in Hematology, Transfusion and Cell Therapy.
AIHA, of which cold agglutinin disease is a subtype, is characterized by the development of antibodies against antigens on autologous erythrocytes. Once a diagnosis is made, detailed laboratory investigations are usually carried out to identify the presence of coexisting primary diseases, if any. One such investigation is the detection of the antinuclear antibody via immunofluorescence studies.
“Many times patients are positive for FANA with no obvious evidence of underlying connective tissue disease,” Rangnekar and colleagues wrote. “We wanted to see if the nature of the disease differs in patients with FANA positive AIHA from that of FANA negative AIHA, in terms of disease presentation, treatment response, relapse rates and complications.”
Read more about cold agglutinin disease differential diagnosis
The research team conducted their prospective cohort study involving 29 patients with primary AIHA from the Department of Adult Hematology at a tertiary care teaching hospital. Laboratory tests were conducted and FANA investigations were performed on all patients. Patients with AIHA were treated according to existing protocols.
The results demonstrated that baseline FANA positivity was detected in a total of 17 patients out of the 29 patients studied. Laboratory results did not yield any notable dissimilarities between FANA positive and FANA negative patients.
Notably, FANA-positive patients demonstrated a significantly higher rate of relapse per patient month follow-up, lower complete response rates, and lower relapse-free survival at 5 years. Evan’s syndrome was also detected in 6 of the FANA-positive patients studied.
“A baseline FANA at the time of diagnosis of AIHA has to be established for all patients. The presence of FANA will give us a prognostic value and help us in deciding the treatment options,” the researchers concluded.
Rangnekar A, Shenoy S, Mahabala C, Balanthimogru P. Impact of baseline fluorescent antinuclear antibody positivity on the clinical outcome of patients with primary autoimmune hemolytic anemia. Hematol Transfus Cell Ther. Published online March 4, 2022. doi:10.1016/j.htct.2022.01.013