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Summary: A subset of individuals with 'primary' or 'idiopathic' immune thrombocytopenia (ITP) who fail to respond to conventional first‐ and second‐line agents or who lose responsiveness are considered to have 'refractory' disease (rITP), placing them at increased risk of bleeding and complications of intensive treatment. However, the criteria used to define the refractory state vary among studies, which complicates research and clinical investigation. Moreover, it is unclear whether rITP is simply 'more severe' ITP, or if there are specific pathogenic pathways that are more likely to result in refractory disease, and whether the presence or development of rITP can be established or anticipated based on these differences. This paper reviews potential biological features that may be associated with rITP, including genetic and epigenetic risk factors, dysregulation of T cells and cytokine networks, antibody affinity and specificity, activation of complement, impaired platelet production and alterations in platelet viability and clearance. These findings indicate the need for longitudinal studies using novel clinically available methodologies to identify and monitor pathogenic T cells, platelet antibodies and other clues to the development of refractory disease. [ABSTRACT FROM AUTHOR]

Summary: Patients with sickle cell disease (SCD) are considered to be immunocompromised, yet data on the antibody response to SARS‐CoV‐2 vaccination in SCD is limited. We investigated anti‐SARS‐CoV‐2 IgG titres and overall neutralizing activity in 201 adults with SCD and demographically matched non‐SCD controls. Unexpectedly, patients with SCD generate a more robust and durable COVID‐19 vaccine IgG response compared to matched controls, though the neutralizing activity remained similar across both cohorts. These findings suggest that patients with SCD achieve a similar antibody response following COVID‐19 vaccination compared to the general population, with implications for optimal vaccination strategies for patients with SCD. [ABSTRACT FROM AUTHOR]

Anti-spike antibody levels significantly increased by exposure number (i.e., vaccination and/or infection, I R i SP 2 sp = 0.34, I p i < 0.001), but anti-nucleocapsid antibody levels did not (Figure 1E,F). Anti-spike and anti-nucleocapsid antibody levels were quantified in 36 patients with sickle cell disease (SCD) and 22 control patients without SCD seen in the same haematology adult and paediatric clinics. All SCD participants and 95% of controls had detectable anti-spike protein antibodies; 21 (58.3%) and 11 (50.0%) had anti-nucleocapsid antibodies, respectively. Keywords: antibodies; coronavirus 2019 (COVID-19); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); sickle cell disease; splenic function EN antibodies coronavirus 2019 (COVID-19) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sickle cell disease splenic function 680 683 4 08/10/22 20220815 NES 220815 Antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and/or vaccination reduces infection risk.1 In the United States, people with sickle cell disease (SCD) have experienced considerable complications from SARS-CoV-2 infection.2,3 Functional hyposplenia, asplenia, or splenectomy in SCD can increase pathogen susceptibility and reduce vaccine responsiveness.4 We evaluated serum antibody levels for anti-nucleocapsid antibodies from past infection and anti-spike antibodies from vaccination and/or past infection in people with SCD. [Extracted from the article]

Summary: Patients with multiple myeloma (MM) have a suboptimal antibody response following vaccination against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and lower seroconversion rates following coronavirus disease 2019 (COVID‐19) compared with healthy individuals. In this context, we evaluated the development of neutralising antibodies (NAbs) against SARS‐CoV‐2 in non‐vaccinated patients with MM and COVID‐19 compared with patients after vaccination with two doses of the BNT162b2 vaccine. Serum was collected either four weeks post confirmed diagnosis or four weeks post a second dose of BNT162b2. NAbs were measured with a Food and Drug Administration‐approved enzyme‐linked immunosorbent assay methodology. Thirty‐five patients with COVID‐19 and MM along with 35 matched patients were included. The two groups did not differ in age, sex, body mass index, prior lines of therapy, disease status, lymphocyte count, immunoglobulin levels and comorbidities. Patients with MM and COVID‐19 showed a superior humoral response compared with vaccinated patients with MM. The median (interquartile range) NAb titre was 87·6% (71·6–94%) and 58·7% (21·4–91·8%) for COVID‐19‐positive and vaccinated patients, respectively (P = 0·01).Importantly, there was no difference in NAb production between COVID‐19‐positive and vaccinated patients who did not receive any treatment (median NAb 85·1% vs 91·7%, P = 0·14). In conclusion, our data indicate that vaccinated patients with MM on treatment without prior COVID‐19 should be considered for booster vaccine doses. [ABSTRACT FROM AUTHOR]

Summary: Inhibitor development is a major complication of treatment with factor VIII concentrates in nonsevere haemophilia A. It has been suggested that plasma‐derived factor VIII (FVIII) concentrates elicit fewer inhibitors than recombinant FVIII concentrates, but studies in severe haemophilia A patients have shown conflicting results. We designed a case‒control study to investigate the clinical and genetic risk factors for inhibitor development in nonsevere haemophilia A patients. We investigated whether the type of FVIII concentrate was associated with inhibitor development in nonsevere haemophilia A patients. This nested case‒control study includes 75 inhibitor patients and 223 controls, from a source population of the INSIGHT study, including all nonsevere haemophilia A patients (FVIII:C 2–40%) that were treated with FVIII concentrates in 33 European and one Australian centre. Cases and controls were matched for date of birth and cumulative number of exposure days (CED) to FVIII concentrate. A conditional logistic regression model was used to calculate unadjusted and adjusted odds ratios. No increased risk for inhibitor development was found for any type of FVIII concentrate; either when comparing recombinant FVIII concentrates to plasma‐derived FVIII concentrates (adjusted odds ratio 0·96, 95% confidence interval (CI) 0·36–2·52) or for specific types of FVIII concentrates. [ABSTRACT FROM AUTHOR]

Haemolytic disease of the fetus and newborn (HDFN) is a severe disease in which fetal red blood cells (RBC) are destroyed by maternal anti-RBC IgG alloantibodies. HDFN is most often caused by anti-D but may also occur due to anti-K, -c- or -E. We recently found N-linked glycosylation of anti-D to be skewed towards low fucosylation, thereby increasing the affinity to IgG-Fc receptor IIIa and IIIb, which correlated with HDFN disease severity. Here, we analysed 230 pregnant women with anti-c, -E or -K alloantibodies from a prospective screening cohort and investigated the type of Fc-tail glycosylation of these antibodies in relation to the trigger of immunisation and pregnancy outcome. Anti-c, -E and -K show - independent of the event that had led to immunisation - a different kind of Fc-glycosylation compared to that of the total IgG fraction, but with less pronounced differences compared to anti-D. High Fc-galactosylation and sialylation of anti-c correlated with HDFN disease severity, while low anti-K Fc-fucosylation correlated with severe fetal anaemia. IgG-Fc glycosylation of anti-RBC antibodies is shaped depending on the antigen. These features influence their clinical potency and may therefore be used to predict severity and identify those needing treatment. [ABSTRACT FROM AUTHOR]