The pathophysiology of paroxysmal nocturnal hemoglobinuria and treatment with eculizumab
Richard Kelly1, Stephen Richards1, Peter Hillmen1, Anita Hill2
1Institute of Oncology, St. James’s University Hospital, Leeds, UK; 2Department of Haematology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
Abstract: Paroxysmal nocturnal hemoglobinuria is a rare disorder of hemopoietic stem cells. Affected individuals have a triad of clinical associations – intravascular hemolysis, an increased risk of thromboembolism, and bone marrow failure. Most of the symptoms experienced in this disease occur due to the absence of complement regulatory proteins on the surface of the red blood cells. Complement activation is thus not checked and causes destruction of these cells. Eculizumab is a monoclonal antibody treatment which specifically binds to the complement protein C5, preventing its cleavage, and so halts the complement cascade and prevents the formation of the terminal complement proteins. Eculizumab prevents intravascular hemolysis, stabilizes hemoglobin levels, reduces or stops the need for blood transfusions, and improves fatigue and patient quality of life as well as reducing pulmonary hypertension, decreasing the risk of thrombosis and protecting against worsening renal function. It is not a curative therapy but has a great benefit on those with this rare debilitating condition.
Keywords: eculizumab, paroxysmal nocturnal hemoglobinuria, hemolysis
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