Immunohematology Program

The Montefiore Einstein Immunohematology Program is a premier destination, providing comprehensive and personalized care for adults and children with a wide range of immune hematologic disorders. These include immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), antiphospholipid antibody syndrome (APS), warm antibody autoimmune hemolytic anemia (wAIHA), cold agglutinin disease (CAD), autoimmune neutropenia, Evans syndrome, and complement disorders such as paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS).

Our multidisciplinary team of world-renowned hematologists, immunologists, rheumatologists, nephrologists, geneticists and other specialists ensure a comprehensive approach to care at locations in the Bronx,and the broader New York metropolitan area, including Westchester County and Hudson Valley. Our team of doctors specializes in diagnosing rare and complex autoimmune hematologic conditions, using a research-based and patient-centered care approach tailored to addressing the unique needs of each individual. We also work together with a dedicated multidisciplinary thrombotic microangiopathy (TMA) team to ensure rapid evaluation, early diagnosis and timely treatment of TMAs to ensure optimal outcomes. We use the most advanced diagnostics and leading-edge treatments, including access to numerous clinical trials, enabling our patients to benefit from the latest advancements in rare autoimmune hematologic disorders that may not be available to the general public.

We are a referral site for the most complex cases. Our program offers a complete spectrum of services from prevention, diagnosis and treatment to providing access to genetic counseling, patient support organizations and education. We also collaborate with the Center for Genetically-Driven Blood and Immune Disorders, one of the first and only clinics in the country dedicated to the multidisciplinary care of patients with genetically-driven blood and immune disorders. At Montefiore Einstein Immunohematology, we are committed to providing the highest‑quality care, improving outcome and ensuring that every patient receives exceptional and specialized hematology care.

We use the latest diagnostics and treatments for the prevention, diagnosis and management of the full range of immune hematologic disorders in adults and children. Our team offers comprehensive, personalized care focused on optimizing health and quality of life.

In addition to complete blood count, reticulocyte count and peripheral blood smear analysis, we conduct extensive clinical and laboratory diagnostic evaluations using the most advanced laboratory testing. These include advanced coagulation studies, platelet analysis, antiplatelet autoantibody and immunoglobulin studies, indirect antiglobulin tests and direct antiglobulin testing evaluating the presence of immunoglobulin and/or a complement on the surface of red blood cells. Additional diagnostics include ADAMTS13 testing; complement testing; TMA and immune deficiency evaluation; and workups for other associated genetic, lymphoproliferative, autoimmune and metabolic conditions. We also offer access to genetic testing with massively parallel sequencing to facilitate precision medicine approaches. We use advanced imaging, including computed tomography (CT) and 3T magnetic resonance imaging (MRI), and screen for infections that might be linked to ITP and other conditions. For certain cases, we also offer the latest bone marrow aspiration and biopsy techniques.

Depending on the diagnosis and other factors such as blood count, symptoms and prior treatments, we offer a full range of the latest personalized and targeted treatments. Lifestyle modification and supportive measures are offered, such as avoiding cold exposure for patients with CAD or stopping drug therapy for patients with drug-induced autoimmune hemolytic anemia, as well as other supportive therapies such as platelet or red blood cell transfusions, recombinant erythropoietin for patients with antibody autoimmune hemolytic anemia (AIHA) with inadequate reticulocyte counts, and thrombotic and antibiotic prophylaxis.

We offer access to the most advanced pharmacologic treatments, from traditional medications such as corticosteroids and other immunosuppressive agents, intravenous immunoglobulin, platelet transfusion and hemostatic therapies, such as tranexamic acid, to newly emerging therapies. We provide access to a wide range of monoclonal antibody therapies that target different parts of the immune system, such as rituximab (chimeric anti-CD20 antibody), complement inhibitors such as sutimlimab (anti-C1s), eculizumab (anti-C5), ravulizumab (anti-C5), pegcetacoplan (anti-C3) and iptacopan (anti-factor B) for patients with complement disorders. Additionally, we provide fostamatinib (​​a spleen tyrosine kinase inhibitor) for patients with previous thrombotic events and thrombopoietin receptor agonists (such as eltrombopag or romiplostim) for the treatment of chronic immune thrombocytopenia.

For AIHA, we offer access to a variety of emerging therapies, including B-cell-directed therapy (CD20, PI3K, BTK, BAFF and mTOR inhibition), phagocytosis inhibition (​​Syk and FcRn inhibition), plasma cell-directed therapy (proteasome inhibition and CD38 monoclonal antibodies) and complement inhibition with C1s inhibitor sutimlimab.

For complement-mediated intravascular hemolysis in conditions such as PNH and aHUS, we offer access to novel complement inhibitors, including C5 inhibitors such as eculizumab, longer-acting ravulizumab and eculizumab biosimilars. We also offer recently approved proximal complement inhibitors pegcetacoplan, iptacopan and danicopan, as well as other newly emerging treatments targeting multiple sites within the complement pathway.

In refractory cases, removal of the spleen (splenectomy) may be indicated. In these cases, our team of internationally recognized surgeons uses the latest open, minimally invasive and robotic surgical approaches.

We are leading collaborative research and spearheading numerous studies and clinical trials, some of which are investigator-initiated, industry-funded and sponsored by the National Institutes of Health. Through our clinical trials, our patients can access emerging technologies and innovative treatments that are otherwise unavailable to the general public.

We have been involved in numerous clinical trials evaluating the efficacy and safety of a variety of novel medications for the treatment of immune hematologic conditions such as wAIHA, CAD, ITP, TTP, aHUS and PNH. We are also studying B-cell-activating factor inhibitors as a potential immunomodulatory therapy in wAIHA and recently published the results from a phase 2, open-label study of parsaclisib for the treatment of primary AIHA. We also published a retrospective cohort study describing real-world treatment patterns and healthcare resource utilization of patients with wAIHA initiating first-line therapy of oral corticosteroids with or without rituximab.

We were also instrumental in developing consensus recommendations for the diagnosis and management of Evans syndrome in adults.

Immune hematologic disorders are a broad group of conditions in which the immune system attacks blood cells by producing autoantibodies that target and destroy an individual’s red blood cells, white blood cells and/or platelets, causing cytopenias (low levels of these cells) or by activating the complement system, which can cause tissue damage and trigger systemic inflammation. These conditions can be associated with underlying immunodeficiency, systemic autoimmunity, certain medications, transplacental transfer of maternal alloantibodies and antibodies to clotting factors, which can result in thrombosis and hemorrhage. They can also cause hemolytic and nonhemolytic reactions during blood transfusions.

The autoimmune cytopenias include ITP, AIHA, wAIHA, CAD, autoimmune neutropenia and Evans syndrome. TTP is most commonly immune-mediated due to autoantibodies that inhibit plasma ADAMTS13 activity, but it can sometimes be inherited. APS is an autoimmune disorder where autoantibodies attack phospholipids and can increase the risk of blood clots. Complement-mediated disorders, such as PNH and aHUS, can also lead to hemolysis and thrombosis. Understanding the pathophysiology behind autoimmune hematologic disorders and providing proper preventative and therapeutic care are essential in reducing morbidity and preventing the risk of complications.