Mathieu Uzzan1, Lionel Galicier2, Jean-Marc Gornet3, Eric Oksenhendler2, Claire Fieschi2, Matthieu Allez3, Yoram Bouhnik4, Julien Kirchgesner5, David Boutboul2, Xavier Treton4, Laurence Gérard2, Matthieu Mahévas6, Jacques Cosnes5, Aurélien Amiot7. 1. Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, AP-HP, University Paris 7 Denis Diderot, Clichy, France. Electronic address: mathieuuzzan@gmail.com. 2. Department of Clinical Immunology and EA3518, Saint-Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France. 3. Department of Gastroenterology, Saint Louis Hospital, AP-HP, University Paris 7 Denis Diderot, Paris, France. 4. Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, AP-HP, University Paris 7 Denis Diderot, Clichy, France. 5. Department of Gastroenterology, Saint-Antoine Hospital, AP-HP, UPMC University Paris 6 Pierre et Marie Curie, Paris, France. 6. Department of Internal Medicine, Henri Mondor Hospital, AP-HP, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France. 7. Department of Gastroenterology, Henri Mondor Hospital, AP-HP, EC2M3-Equipe Universitaire, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France.
Abstract
INTRODUCTION: Autoimmune cytopenias (AIC) including autoimmune hemolytic anemia (AIHA) and immunologic thrombocytopenia (ITP) are rare immunologic disorders, scarcely reported in inflammatory bowel diseases (IBD). We conducted a multicentric retrospective study, including a case-control analysis, that aimed to describe the characteristics and outcomes of patients affected by AIC and IBD. METHOD: Forty cases were recruited from 4 IBD centers and 2 AIC tertiary centers. Controls were recruited from the MICISTA registry. RESULTS: From the MICISTA registry, incidences were estimated at 4.1/100,000 patient-years and 12.5/100,000 patient-years after IBD diagnosis for AIHA and ITP, respectively. All AIHA patients (n=14) had colonic involvement (13/14 with UC), whereas CD (52%) and UC (48%) diagnoses were evenly distributed among ITP patients. Compared to control IBD patients, cases were characterized by a higher frequency of extra-intestinal manifestations (37.5% vs 17%, p<0.001) and by the presence of IBD severity's hallmark. AIHA and IBD ran mainly in parallel, and 12 out of 14 AIHA were warm AIHA. In isolated cases, rituximab and infliximab were efficient to treat IBD and AIC, respectively. IBD surgery may induce AIC remission in some cases. CONCLUSION: Although low, incidence of AIC appears higher in IBD patients compared to the general population. The association seems to be mainly non-fortuitous, especially for colitis-associated AIHA.
INTRODUCTION:Autoimmune cytopenias (AIC) including autoimmune hemolytic anemia (AIHA) and immunologic thrombocytopenia (ITP) are rare immunologic disorders, scarcely reported in inflammatory bowel diseases (IBD). We conducted a multicentric retrospective study, including a case-control analysis, that aimed to describe the characteristics and outcomes of patients affected by AIC and IBD. METHOD: Forty cases were recruited from 4 IBD centers and 2 AIC tertiary centers. Controls were recruited from the MICISTA registry. RESULTS: From the MICISTA registry, incidences were estimated at 4.1/100,000 patient-years and 12.5/100,000 patient-years after IBD diagnosis for AIHA and ITP, respectively. All AIHA patients (n=14) had colonic involvement (13/14 with UC), whereas CD (52%) and UC (48%) diagnoses were evenly distributed among ITPpatients. Compared to control IBD patients, cases were characterized by a higher frequency of extra-intestinal manifestations (37.5% vs 17%, p<0.001) and by the presence of IBD severity's hallmark. AIHA and IBD ran mainly in parallel, and 12 out of 14 AIHA were warm AIHA. In isolated cases, rituximab and infliximab were efficient to treat IBD and AIC, respectively. IBD surgery may induce AIC remission in some cases. CONCLUSION: Although low, incidence of AIC appears higher in IBD patients compared to the general population. The association seems to be mainly non-fortuitous, especially for colitis-associated AIHA.