{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:27:18Z","timestamp":1774592838532,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T00:00:00Z","timestamp":1685145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by hemolysis and thrombosis and is associated with significant morbidity and mortality. Although complement inhibitors have significantly changed the outcomes in PNH patients, breakthrough hemolysis (BTH) may still occur as a response to stress factors such as pregnancy, surgery, and infections. Despite the well-described association between bacterial infections and hemolysis in PNH patients, little is known about the effect of respiratory viruses on triggering hemolytic episodes. This is the first study, to our knowledge, addressing this question. We retrospectively analyzed 34 patients with PNH disease between 2016 and 2018, who were on eculizumab treatment and who presented with respiratory symptoms and were subsequently tested for 10 respiratory viruses (influenza A, influenza B, parainfluenza, respiratory syncytial virus, adenovirus, rhinovirus, and human metapneumovirus). NTS+ patients had higher inflammatory markers, with the majority requiring antibiotics. Acute hemolysis, along with a significant drop in hemoglobin, was noted in the NTS+ group, with three of them requiring a top-up transfusion and two requiring an extra dose of eculizumab. Furthermore, the time from the last eculizumab dose was longer in the NTS+ patients who had BTH, than those who did not. Our data indicate that respiratory virus infections pose a significant risk for BTH in PNH patients on complement inhibitor treatment, underlining the need for regular screening and close monitoring of patients with respiratory symptoms. Furthermore, it implies a higher risk for patients who are not established on complement inhibitors, suggesting the necessity for greater vigilance in these patients.<\/jats:p>","DOI":"10.3390\/ijms24119358","type":"journal-article","created":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T16:19:37Z","timestamp":1685204377000},"page":"9358","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Effect of Respiratory Viral Infections on Breakthrough Hemolysis in Patients with Paroxysmal Nocturnal Hemoglobinuria"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5162-1304","authenticated-orcid":false,"given":"Ioanna","family":"Lazana","sequence":"first","affiliation":[{"name":"Department of Hematological Medicine, King\u2019s College Hospital-NHS Foundation Trust, London SE5 9RS, UK"},{"name":"Cell and Gene Therapy Laboratory, Biomedical Research Foundation of the Academy of Athens, 115 27 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Apap Mangion","sequence":"additional","affiliation":[{"name":"Department of Hematological Medicine, King\u2019s College Hospital-NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selma","family":"Babiker","sequence":"additional","affiliation":[{"name":"Department of Hematological Medicine, King\u2019s College Hospital-NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Large","sequence":"additional","affiliation":[{"name":"Department of Hematological Medicine, King\u2019s College Hospital-NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roochi","family":"Trikha","sequence":"additional","affiliation":[{"name":"Department of Hematological Medicine, King\u2019s College Hospital-NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0384-3970","authenticated-orcid":false,"given":"Mark","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Department of Virology, King\u2019s College NHS Foundation Trust, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shreyans","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Hematological Medicine, King\u2019s College Hospital-NHS Foundation Trust, London SE5 9RS, UK"},{"name":"Faculty of Life Sciences and Medicine, King\u2019s College London, London WC2R 2LS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin G.","family":"Kulasekararaj","sequence":"additional","affiliation":[{"name":"Department of Hematological Medicine, King\u2019s College Hospital-NHS Foundation Trust, London SE5 9RS, UK"},{"name":"Faculty of Life Sciences and Medicine, King\u2019s College London, London WC2R 2LS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1056\/NEJM199511093331904","article-title":"Natural History of Paroxysmal Nocturnal Hemoglobinuria","volume":"333","author":"Hillmen","year":"1995","journal-title":"N. 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