Case report: passive transfer of hepatitis B antibodies from intravenous immunoglobulin

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• 作者：Simon Parker (7)
  Eliza Gil (8)
  Patricia Hewitt (8)
  Katherine Ward (9)
  Yasmin Reyal (10)
  Sasha Wilson (10)
  Jessica Manson (11)
  
• 关键词：Hepatitis B virus ; Intravenous immunoglobulin ; Passive antibody transfer ; Seronegative inflammatory polyarthritis ; Lymphoma ; Haematopoietic stem cell transplant ; Immunosuppression
• 刊名：BMC Infectious Diseases
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：178 KB
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  3. Stroffolini T, Gaeta GB, Mele A: AASLD practice guidelines on chronic hepatitis B and HBV infection in Italy . / Hepatology 2007,46(2):608-09. author reply 609 CrossRef
  4. Loomba R, Rowley A, Wesley R, Liang TJ, Hoofnagle JH, Pucino F, / et al.: Systematic review: the effect of preventive lamivudine on hepatitis B reactivation during chemotherapy. / Ann Intern Med 2008,148(7):519-28. CrossRef
  5. Evens AM, Jovanovic BD, Su YC, Raisch DW, Ganger D, Belknap SM, / et al.: Rituximab-associated hepatitis B virus (HBV) reactivation in lymphoproliferative diseases: meta-analysis and examination of FDA safety reports. / Ann Oncol 2011,22(5):1170-180. CrossRef
  6. Pei SN, Chen CH, Lee CM, Wang MC, Ma MC, Hu TH, / et al.: Reactivation of hepatitis B virus following rituximab-based regimens: a serious complication in both HBsAg-positive and HBsAg-negative patients. / Ann Hematol 2010,89(3):255-62. CrossRef
  7. Nunes J, Marinho RT, Fonseca JE, da Silva JA P, Velosa J: Prophylaxis of hepatitis B reactivation with immunosuppressive therapy in rheumatic diseases. Orientations for clinical practice. / Acta Reumatol Port 2011,36(2):110-18.
  8. Anderson D, Ali K, Blanchette V, Brouwers M, Couban S, Radmoor P, / et al.: Guidelines on the use of intravenous immune globulin for hematologic conditions. / Transfus Med Rev 2007,21(2 Suppl 1):S9-S56. CrossRef
  9. Lichtiger B, Rogge K: Spurious serologic test results in patients receiving infusions of intravenous immune gammaglobulin. / Arch Pathol Lab Med 1991,115(5):467-69.
  10. Pelloux H, Fricker-Hidalgo H, Brochier G, Goullier-Fleuret A, Ambroise-Thomas P: Intravenous immunoglobulin therapy: confounding effects on serological screening for toxoplasmosis during pregnancy. / J Clin Microbiol 1999,37(10):3423-424.
  11. Rossi KQ, Nickel JR, Wissel ME, O’Shaughnessy RW: Passively acquired treponemal antibody from intravenous immunoglobulin therapy in a pregnant patient. / Arch Pathol Lab Med 2002,126(10):1237-238.
  12. Benton E, Iqbal K, Wade P, Wong T, Aarons E, Groves R: False-positive hepatitis B serology following IVIG therapy: forgotten but not gone!! / J Am Acad Dermatol 2012,66(3):e123-e124. CrossRef
  13. Arnold DM, Crowther MA, Meyer RM, Carruthers J, Ditomasso J, Heddle NM, / et al.: Misleading hepatitis B test results due to intravenous immunoglobulin administration: implications for a clinical trial of rituximab in immune thrombocytopenia. / Transfusion 2010,50(12):2577-581. CrossRef
  14. Kohrt HE, Ouyang DL, Keeffe EB: Systematic review: lamivudine prophylaxis for chemotherapy-induced reactivation of chronic hepatitis B virus infection. / Aliment Pharmacol Ther 2006,24(7):1003-016. CrossRef
  15. Altindag A, Cadirci D, Sirmatel F: Depression and health related quality of life in non-cirrhotic chronic hepatitis B patients and hepatitis B carriers. / Neurosciences (Riyadh) 2009,14(1):56-9.
  16. Ozkan M, Corapcioglu A, Balcioglu I, Ertekin E, Khan S, Ozdemir S, / et al.: Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C. / Int J Psychiatry Med 2006,36(3):283-97. CrossRef
  17. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2334/14/99/prepub
  
• 作者单位：Simon Parker (7)
  Eliza Gil (8)
  Patricia Hewitt (8)
  Katherine Ward (9)
  Yasmin Reyal (10)
  Sasha Wilson (10)
  Jessica Manson (11)
  
  7. Flat 19, 3?St Pancras Way, London, NW1 0PB, UK
  8. Department of Rheumatology, University College London Hospitals, 3rd Floor, 250 Euston Road, London, NW1 2PG, UK
  9. Division of Infection & Immunity, University College London, Room 133, 74 Huntley Street, London, WC1E 6AU, UK
  10. Haematology and Blood Transfusion, University College London, 60 Whitfield Street, London, W1T 4EU, UK
  11. Transfusion Microbiology Office, NHSBT Colindale, Charcot Road, Colindale, London, NW9 5BG, UK
  
• ISSN：1471-2334

文摘

Background Prior to initiating immunosuppressive therapy in the treatment of autoimmune inflammatory conditions, it is a requirement to screen for certain viral serology, including hepatitis B (HBV). A positive result may indicate the need for antiviral therapy, or contraindicate immunosuppression all together. An accurate interpretation of serological markers is therefore imperative in order to treat patients appropriately. We present a case of passive anti-HBV antibody transfer following intravenous immunoglobulin (IVIg) infusion, in which misinterpretation of serology results almost led to inappropriate treatment with antiviral therapy and the withholding of immunosuppressive agents. This phenomenon has been previously reported, but awareness remains limited. Case presentation A 50?year old Caucasian gentleman with a history of allogeneic haematopoietic stem cell transplant for transformed follicular lymphoma was admitted to hospital with recurrent respiratory tract infections. Investigation found him to be hypogammaglobulinaemic, and he was thus given 1?g/kg of intravenous immunoglobulin. The patient also disclosed a 3-week history of painful, swollen joints, leading to a diagnosis of seronegative inflammatory polyarthritis. Prior to initiating long term immunosuppression, viral screening found hepatitis B serology suggestive of past infection, with positive results for both anti-HBc and anti-HBs antibody, but negative HBV DNA. In response, prednisolone was weaned and the local hepatology team recommended commencement of lamivudine. Having been unable to identify a source of infection, the case was reported to the local blood centre, who tested a remaining vial from the same batch of IVIg and found it to be anti-HBc and anti-HBs positive. Fortunately the blood products were identified and tested prior to the patient initiating HBV treatment, and the effect of a delay in starting disease-modifying therapy was inconsequential in light of an excellent response to first-line therapies. Conclusion Misinterpretation of serology results following IVIg infusion may lead to significant patient harm, including unnecessary antiviral administration, the withholding of treatments, and psychosocial damage. This is especially pertinent at a time when we have an ever increasing number of patients being treated with IVIg for a wide array of immune-mediated disease. Passive antibody transfer should be considered wherever unexpected serological changes are identified.