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Bianchetti_2025_MDPI_jcm_Hemolytic anemia
Journal article

Hemolytic anemia linked to Epstein-Barr virus infectious mononucleosis : a systematic review of the literature

Università della Svizzera italiana

  • Meloni, Dario F. Institute of Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Faré, Pietro B. Institute of Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
  • Milani, Gregorio P. Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy - Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
  • Lava, Sebastiano A. G. Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
  • Bianchetti, Mario G. ORCID Institute of Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Renzi, Samuele Division of Hematology and Oncology, CHUL-Laval, Quebec City, Canada - Department of Pediatrics, Laval University, Quebec City, Canada
  • Bertacchi, Massimiliano Pediatric Nephrology Unit, Geneva University Hospitals, Switzerland
  • Kottanattu, Lisa ORCID Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland - Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Bronz, Gabriel ORCID Institute of Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Department of Internal Medicine, Regional Hospital of Locarno, Ente Ospedaliero Cantonale, Switzerland
  • Camozzi, Pietro Department of Anesthesia, Hôpital du Valais, Sion, Switzerland
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  • 2025
Published in:
  • Journal of clinical medicine. - 2025, vol. 14, no. 4, p. 1283
Epstein–Barr virus
Infectious mononucleosis
Hemolysis
Cold antibodies
Warm antibodies
English Background: In Epstein–Barr virus infectious mononucleosis, hemolytic anemia occasionally occurs. Methods: To characterize hemolytic anemia linked to Epstein–Barr virus infectious mononucleosis, we performed a systematic review (PROSPERO CRD42024597183) in the United States National Library of Medicine, Excerpta Medica, and Web of Science with no restrictions on language. Only reports published since 1970 were included. Eligible were reports describing hemolytic anemia in subjects with clinical signs and microbiological markers of Epstein–Barr virus mononucleosis. Results: In the literature, we detected 56 reports released between 1973 and 2024, documenting 60 individuals (32 females and 28 males; 27 children and 33 adults) with hemolytic anemia linked to Epstein–Barr virus infectious mononucleosis. The mechanism underlying anemia was categorized as cold-antibody-mediated (N = 31; 52%), warm-antibody-mediated (N = 18, 30%), mixed warm- and cold-antibody-mediated (N = 4; 6.7%), or paroxysmal cold hemoglobinuria (N = 2; 3.3%). The remaining 5 cases (8.3%) remained unclassified. Observation alone was the chosen approach in 23% of cases (N = 14). Steroids (67%; N = 40) and blood transfusions (38%; N = 23) were the most commonly used treatment, while plasma exchange, intravenous polyclonal immunoglobulin, rituximab, and splenectomy were used less frequently. Observation was slightly but significantly (p = 0.032) more common in cases of cold-antibody-mediated anemia compared to all other cases combined. Patients recovered a median of 28 [interquartile range 21–39] days after disease onset. Two patients with warm-antibody-mediated hemolytic anemia died. Conclusions: This literature review points out that Epstein–Barr virus, like Mycoplasma pneumoniae, cytomegalovirus, or severe acute respiratory syndrome coronavirus 2, may act as a trigger for immune-mediated hemolytic anemia.
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  • English
Classification
Medicine
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CC BY
Open access status
gold
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https://n2t.net/ark:/12658/srd1331845
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