An expert panel recently published guidance in Hematology, recommending tailored interventions in the management of pharmacodynamic breakthrough hemolysis (BTH). Despite the positive impact of complement inhibitors on paroxysmal nocturnal hemoglobinuria (PNH) treatment, patients face challenges such as BTH, particularly after exposure to complement-amplifying conditions like infections, vaccinations, and surgeries. David Dingli, MD, PhD, and colleagues, used the RAND/UCLA-modified Delphi method to achieve consensus on managing BTH amid such conditions. The panel also proposed a BTH severity classification and preventive strategies for high-risk scenarios. After thorough literature review and assessment of over 400 clinical scenarios, 77% agreement was reached on the management approaches. The consensus, primarily driven by expert experience and opinion in the absence of randomized trial data, offers a critical framework for treating BTH, according to the article. The recommendations highlight the importance of tailored interventions to significantly enhance care for patients with PNH.
