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CC BY 4.0 · TH Open 2019; 03(03): e306-e308
DOI: 10.1055/s-0039-1697642
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Georg Thieme Verlag KG Stuttgart · New York

The (Fab)ulous Destiny of Idarucizumab: Highlighting Its Interference with Urine Protein Immunofixation

Nicolas Gendron
1   Laboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
2   Université de Paris, INSERM, U1148, Paris, France
,
Héloïse Flament
3   Laboratoire d'Immunologie-Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
4   Université de Paris, INSERM, U1149, Paris, France
,
Elena Litvinova
3   Laboratoire d'Immunologie-Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
4   Université de Paris, INSERM, U1149, Paris, France
,
Sofia Ortuno
5   Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
,
Nadine Ajzenberg
1   Laboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
2   Université de Paris, INSERM, U1148, Paris, France
,
Dorothée Faille
1   Laboratoire d'Hématologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
2   Université de Paris, INSERM, U1148, Paris, France
› Author Affiliations
Further Information

Publication History

15 April 2019

05 August 2019

Publication Date:
16 September 2019 (online)

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Abstract

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.

Keywords

idarucizumab - dabigatran - reversal - immunofixation - paraprotein
 

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