The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation
Idarucizumab is a humanized antigen binding fragment (Fab) of a recombinant anti-dabigatran monoclonal antibody (IgG1-kappa) that allows rapid and sustained reversal of dabigatran-induced anticoagulation in case of bleeding or urgent surgery. Herein, we report a very unusual case of dabigatran rever...
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Georg Thieme Verlag KG
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doaj-15da4c3126ee458f81ea496c23dd3b842020-11-25T01:58:28ZengGeorg Thieme Verlag KGTH Open2512-94652512-94652019-07-010303e306e30810.1055/s-0039-1697642The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein ImmunofixationNicolas Gendron0Héloïse Flament1Elena Litvinova2Sofia Ortuno3Nadine Ajzenberg4Dorothée Faille5Laboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, FranceLaboratoire d'Immunologie-Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, FranceLaboratoire d'Immunologie-Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, FranceService de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, FranceLaboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, FranceLaboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, FranceIdarucizumab is a humanized antigen binding fragment (Fab) of a recombinant anti-dabigatran monoclonal antibody (IgG1-kappa) that allows rapid and sustained reversal of dabigatran-induced anticoagulation in case of bleeding or urgent surgery. Herein, we report a very unusual case of dabigatran reversal by idarucizumab in a 79-year-old woman with acute kidney failure admitted to a hospital in a context of hemoptysis. Three repeated injections were necessary because of massive dabigatran overdose and high rebounds of dabigatran plasma concentration. Idarucizumab was found on urine immunofixation up to 6 days after the last injection where it reacted with anti-kappa light chain antibody, but not with anti-gamma heavy chain antibody. Physicians should be aware of the increased half-life of idarucizumab in this context of acute kidney impairment and of its interference with urine immunofixation because it could lead to false-positive results and misdiagnosis of a paraprotein.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1697642idarucizumabdabigatranreversalimmunofixationparaprotein |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nicolas Gendron Héloïse Flament Elena Litvinova Sofia Ortuno Nadine Ajzenberg Dorothée Faille |
spellingShingle |
Nicolas Gendron Héloïse Flament Elena Litvinova Sofia Ortuno Nadine Ajzenberg Dorothée Faille The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation TH Open idarucizumab dabigatran reversal immunofixation paraprotein |
author_facet |
Nicolas Gendron Héloïse Flament Elena Litvinova Sofia Ortuno Nadine Ajzenberg Dorothée Faille |
author_sort |
Nicolas Gendron |
title |
The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation |
title_short |
The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation |
title_full |
The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation |
title_fullStr |
The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation |
title_full_unstemmed |
The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation |
title_sort |
(fab)ulous destiny of idarucizumab: highlighting its interference with urine protein immunofixation |
publisher |
Georg Thieme Verlag KG |
series |
TH Open |
issn |
2512-9465 2512-9465 |
publishDate |
2019-07-01 |
description |
Idarucizumab is a humanized antigen binding fragment (Fab) of a recombinant anti-dabigatran monoclonal antibody (IgG1-kappa) that allows rapid and sustained reversal of dabigatran-induced anticoagulation in case of bleeding or urgent surgery. Herein, we report a very unusual case of dabigatran reversal by idarucizumab in a 79-year-old woman with acute kidney failure admitted to a hospital in a context of hemoptysis. Three repeated injections were necessary because of massive dabigatran overdose and high rebounds of dabigatran plasma concentration. Idarucizumab was found on urine immunofixation up to 6 days after the last injection where it reacted with anti-kappa light chain antibody, but not with anti-gamma heavy chain antibody. Physicians should be aware of the increased half-life of idarucizumab in this context of acute kidney impairment and of its interference with urine immunofixation because it could lead to false-positive results and misdiagnosis of a paraprotein. |
topic |
idarucizumab dabigatran reversal immunofixation paraprotein |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1697642 |
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