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| {{Search infobox}} | | __NOTOC__ |
| {{CMG}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Evans syndrome}} |
| | {{CMG}}; {{AE}} {{Ammu}} {{F.Z}} |
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| {{Editor Help}} | | {{SK}} Low grade fibromyxoid sarcoma; Evan's syndrome; Evans' syndrome; AHA/Immune TP; Coombs positive hemolytic anemia; IGG autoimmune hemolytic anemia |
| | ==[[Evans syndrome overview|Overview]]== |
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| ==Overview== | | ==[[Evans syndrome historical perspective|Historical Perspective]]== |
| '''Evans' Syndrome''' is an [[autoimmune]] disease in which an individual's [[antibodies]] attack their own [[Red blood cell|RBC]]s as well as their [[platelets]]. Its overall pathology is therefore effectively a combination of the two [[autoimmune]] induced conditions: [[autoimmune hemolytic anemia]] and [[immune thrombocytopenic purpura]].
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| '''Autoimmune hemolytic anemia''' is a condition in which the [[red blood cells]] that normally carry [[oxygen]] and [[carbon dioxide]] are destroyed by an [[autoimmune]] process. '''Immune thrombocytopenic purpura''' is a condition in which the [[platelets]] in the [[blood]] are destroyed by an [[autoimmune]] process. Platelets are a component of blood that contribute to the formation of [[blood clot]]s in the body to prevent [[bleeding]].
| | ==[[Evans syndrome classification|Classification]]== |
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| ==Those Affected== | | ==[[Evans syndrome pathophysiology|Pathophysiology]]== |
| The incidence of Evan’s Syndrome is not precisely known. The syndrome is reported to be a complication affecting 4-10% of those persons with a particular type of thrombocytopenia known as idiopathic thrombocytopenic purpura. The syndrome is more prevalent in children than in adults. simple symptoms of carriers are breathlessness, feeling faint, shooting pains and a faster heart rate.
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| evans syndrome is extremely serious and can eventually lead to death
| | ==[[Evans syndrome causes|Causes]]== |
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| ==Signs and Symptoms== | | ==[[Differentiating Evans syndrome from other diseases|Differentiating Evans syndrome from other Diseases]]== |
| The signs and symptoms of Evan’s Syndrome will be a combination of the signs and symptoms of the two underlying conditions.
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| In idiopathic thrombocytopenic purpura the following may be found:
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| Bleeding of skin or mucus lined areas of the body. This may show up as bleeding in the mouth, or purpuric rashes (look almost like bruises), or tiny red dots on the skin called petechiae.
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| Laboratory results will show low levels of platelets
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| In autoimmune hemolytic anemia the following may be found:
| | ==[[Evans syndrome epidemiology and demographics|Epidemiology and Demographics]]== |
| Fatigue, Pale skin color, Shortness of breath, Rapid heartbeat,Jaundice colored skin, yellow/jaundice colored eyes, and/or Dark urine
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| ==Possible Causes== | | ==[[Evans syndrome risk factors|Risk Factors]]== |
| The cause of the signs and symptoms of Evan’s Syndrome are directly related to the low levels of red blood cells (RBC) and platelets in the blood. These low levels are a result of circulating antibodies that bind to the blood cells and destroy them. Antibodies are made under normal conditions against foreign substances in the body and are therefore very useful in warding off infection. In conditions that are referred to as “autoimmune” the body makes antibodies against itself. In the case of Evan’s Syndrome, it is not currently known what triggers this reaction to happen.
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| | ==[[Evans syndrome screening|Screening]]== |
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| | ==[[Evans syndrome natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| The diagnosis of Evan’s Syndrome is based primarily on laboratory findings, as well as the corresponding physical signs and symptoms. A complete blood count (CBC) will confirm the presence of anemia and low platelets. Additional studies may include a peripheral smear and a Coombs test. A peripheral smear of the blood may reveal evidence of red blood cell destruction or reticulocytosis. Reticulocytes are immature red blood cells and are usually abundant in Evan’s syndrome where there is a need to replace ongoing losses. There are also distinct shapes to certain cells that may be found when a sample of the patient’s blood is viewed under a microscope. In patients with Evan’s syndrome the red blood cells may appear small and globular shaped (then called spherocytes) but will not be fragmented. A [[Coombs test]] is used to detect the presence of antibodies against the RBC and is usually positive in immune mediated haemolysis.
| | [[Evans syndrome history and symptoms|History and Symptoms]] | [[Evans syndrome physical examination|Physical Examination]] | [[Evans syndrome laboratory findings|Laboratory Findings]] | [[Evans syndrome other imaging findings|Other Imaging Findings]] | [[Evans syndrome other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| The treatment for Evan’s syndrome will involve close monitoring of hemoglobin and platelet counts. To increase the number of platelets and RBCs in the blood, the patient may be given a corticosteroid such as [[prednisone]]. Prednisone will reduce the destruction of the platelets and the RBCs. A certain level of prednisone may need to be taken for the patient's entire life to prevent the levels of platelets and RBCs from dropping. Further treatment may be necessary with immune system suppressing drugs to block the production of the antibodies. To specifically treat the anemia of the syndrome, it may be necessary to provide the child with new RBCs by a blood transfusion. It has not been shown to be effective to transfuse platelets in a similar fashion to treat the thrombocytopenia.
| | [[Evans syndrome medical therapy|Medical Therapy]] | [[Evans syndrome surgery|Surgery]] | [[Evans syndrome primary prevention|Primary Prevention]] | [[Evans syndrome secondary prevention|Secondary Prevention]] | [[Evans syndrome cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Evans syndrome future or investigational therapies|Future or Investigational Therapies]] |
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| 'Note'(((In more severe cases that are unresponsive to treatment, it may become necessary to remove the spleen. The spleen is the organ that is responsible for removing the platelets and RBCs from circulation in the blood once they have been marked with the antibodies. A person can live a normal life without their spleen but, but is at increased risk for certain types of bacterial infections and pneumonia though Current knowledge refutes the effiacy of splenectomy in Evans Syndrome: especially in Adults with a median success rate of 1 month, splenectomy is not really a cure.'''
| | ==Case Studies== |
| | [[Evans syndrome case study one|Case #1]] |
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| A drug, [[Rituxan]], has been giving some good results in acute and refractory Evans syndrome cases. [http://www.mayoclinicproceedings.com/pdf/7811/7811a3.pdf Mayo 2003 study] Search the internet for more current studies on this rare "1:1,000,000 Adults" syndrome. [[Complete blood count | CBC]] and [[Coombs test | Direct Coombs test]] before treatment will give proper diagnosis.
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| ==Prognosis==
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| Given the fact that the signs and symptoms of this disease are related directly to the abnormal laboratory findings, the prognosis depends on the patient’s response to treatment. Spontaneous remissions of each of the individual component conditions have been reported. If the child responds well to the treatment and the levels of platelets and red blood cells increase, the child can expect to live a normal life. Medications will be needed life long, and laboratory tests will need to be constantly monitored to detect any abnormal changes so that treatment can be adjusted.
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| In more serious cases it can massively reduce life span and is seriously life threatening.
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| Evan's Syndrome is rare, serious, and has a reported mortality rate of just under 18%.
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| ==The Future==
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| In a patient with refractory disease, an allogeneic hematopoietic stem cell transplant (HSCT) resulted in complete clinical and serologic remission for more than 30 months. Allogeneic HSCT may be the only current curative therapy for Evans syndrome, but may also be complicated by significant toxicities. In more serious cases no cure exists.
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| ==External links==
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| *http://www.evanssyndrome.net
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| ==References==
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| *http://www.madisonsfoundation.org/content/3/1/display.asp?did=81
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| *http://www.rarediseases.org
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| *http://autoimmune.pathology.jhmi.edu/diseases.cfm?systemid=5
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| * {{cite journal |author=Oyama Y, Papadopoulos EB, Miranda M, Traynor AE, Burt RK |title=Allogeneic stem cell transplantation for Evans syndrome |journal=Bone Marrow Transplant. |volume=28 |issue=9 |pages=903-5 |year=2001 |pmid=11781654 |doi=10.1038/sj.bmt.1703237}}
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| * {{cite journal |author=Evans RS, Takahashi K, Duane RT, Payne R, Liu C |title=Primary thrombocytopenic purpura and acquired hemolytic anemia; evidence for a common etiology |journal=A.M.A. archives of internal medicine |volume=87 |issue=1 |pages=48-65 |year=1951 |pmid=14782741 |doi=}}
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| * {{cite journal |author=Mathew P, Chen G, Wang W |title=Evans syndrome: results of a national survey |journal=J. Pediatr. Hematol. Oncol. |volume=19 |issue=5 |pages=433-7 |year=1997 |month=September/October |pmid=9329465 |doi=}}
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| * {{cite journal |author=Shanafelt TD, Madueme HL, Wolf RC, Tefferi A |title=Rituximab for immune cytopenia in adults: idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, and Evans syndrome |journal=Mayo Clin. Proc. |volume=78 |issue=11 |pages=1340-6 |year=2003 |pmid=14601692 |doi=}}
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| *{{cite journal |author=Shanafelt TD, Madueme HL, Wolf RC, Tefferi A |title=Rituximab for immune cytopenia in adults: idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, and Evans syndrome |journal=Mayo Clin. Proc. |volume=78 |issue=11 |pages=1340-6 |year=2003 |pmid=14601692 |doi= |url=http://www.mayoclinicproceedings.com/pdf/7811/7811a3.pdf |format=pdf}}
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| {{Hematology}}
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| {{SIB}}
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| [[Category:Disease state]] | |
| [[Category:Hematology]] | | [[Category:Hematology]] |
| [[Category:Mature chapter]] | | [[Category:Mature chapter]] |
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