How I diagnose and treat atypical hemolytic uremic syndrome

2.

Fremeaux-Bacchi

V

,

Fakhouri

F

,

Garnier

A

, et al.

Genetics and outcome of atypical hemolytic uremic syndrome: a nationwide French series comparing children and adults

.

Clin J Am Soc Nephrol

.

2013

;

8

(

4

):

554

-

562

.

3.

Schaefer

F

,

Ardissino

G

,

Ariceta

G

, et al.

Clinical and genetic predictors of atypical hemolytic uremic syndrome phenotype and outcome

.

Kidney Int

.

2018

;

94

(

2

):

408

-

418

.

4.

Noris

M

,

Caprioli

J

,

Bresin

E

, et al.

Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype

.

Clin J Am Soc Nephrol

.

2010

;

5

(

10

):

1844

-

1859

.

5.

Legendre

CM

,

Licht

C

,

Muus

P

, et al.

Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome

.

N Engl J Med

.

2013

;

368

(

23

):

2169

-

2181

.

6.

Fakhouri

F

,

Hourmant

M

,

Campistol

JM

, et al.

Terminal complement inhibitor eculizumab in adult patients with atypical hemolytic uremic syndrome: a single-arm, open-label trial

.

Am J Kidney Dis

.

2016

;

2016

(

68

):

84

-

93

.

7.

Le Clech

A

,

Simon-Tillaux

N

,

Provot

F

, et al.

Atypical and secondary hemolytic uremic syndromes have a distinct presentation and no common genetic risk factors

.

Kidney Int

.

2019

;

95

(

6

):

1443

-

1452

.

8.

El Sissy

C

,

Saldman

A

,

Zanetta

G

, et al.

COVID-19 as a potential trigger of complement-mediated atypical HUS

.

Blood

.

2021

;

138

(

18

):

1777

-

1782

.

9.

Fremeaux-Bacchi

V

,

Sellier-Leclerc

AL

,

Vieira-Martins

P

, et al.

Complement gene variants and Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome: retrospective genetic and clinical study

.

Clin J Am Soc Nephrol

.

2019

;

14

(

3

):

364

-

377

.

10.

Chui

L

,

Patterson-Fortin

L

,

Kuo

J

,

Li

V

,

Boras

V

.

Evaluation of enzyme immunoassays and real-time PCR for detecting Shiga toxin-producing Escherichia coli in Southern Alberta, Canada

.

J Clin Microbiol

.

2015

;

53

(

3

):

1019

-

1023

.

11.

George

JN

.

Cobalamin C deficiency-associated thrombotic microangiopathy: uncommon or unrecognised?

.

Lancet

.

2015

;

386

(

9997

):

1012

.

12.

Grange

S

,

Bekri

S

,

Artaud-Macari

E

, et al.

Adult-onset renal thrombotic microangiopathy and pulmonary arterial hypertension in cobalamin C deficiency

.

Lancet

.

2015

;

386

(

9997

):

1011

-

1012

.

13.

Philipponnet

C

,

Desenclos

J

,

Brailova

M

, et al.

Cobalamin c deficiency associated with antifactor H antibody-associated hemolytic uremic syndrome in a young adult

.

BMC Nephrol

.

2020

;

21

(

1

):

96

.

14.

Kalantari

S

,

Brezzi

B

,

Bracciama

V

, et al.

Adult-onset CblC deficiency: a challenging diagnosis involving different adult clinical specialists

.

Orphanet J Rare Dis

.

2022

;

17

(

1

):

33

.

15.

Martins

M

,

Bridoux

F

,

Goujon

JM

, et al.

Complement activation and thrombotic microangiopathy associated with monoclonal gammopathy: a national French case series

.

Am J Kidney Dis

.

2022

;

80

(

3

):

341

-

352

.

16.

Filippone

EJ

,

Newman

ED

,

Li

L

,

Gulati

R

,

Farber

JL

.

Thrombotic microangiopathy, an unusual form of monoclonal gammopathy of renal significance: report of 3 cases and literature review

.

Front Immunol

.

2021

;

12

:

780107

.

17.

Yui

JC

,

Garceau

D

,

Jhaveri

KD

, et al.

Monoclonal gammopathy-associated thrombotic microangiopathy

.

Am J Hematol

.

2019

;

94

(

10

):

E250

-

E253

.

18.

Ravindran

A

,

Go

RS

,

Fervenza

FC

,

Sethi

S

.

Thrombotic microangiopathy associated with monoclonal gammopathy

.

Kidney Int

.

2017

;

91

(

3

):

691

-

698

.

19.

Noris

M

,

Galbusera

M

,

Gastoldi

S

, et al.

Dynamics of complement activation in aHUS and how to monitor eculizumab therapy

.

Blood

.

2014

;

124

(

21

):

1715

-

1726

.

20.

Palomo

M

,

Blasco

M

,

Molina

P

, et al.

Complement activation and thrombotic microangiopathies

.

Clin J Am Soc Nephrol

.

2019

;

14

(

4

):

1719

-

1732

.

21.

Gavriilaki

E

,

Yuan

X

,

Ye

Z

, et al.

Modified Ham test for atypical hemolytic uremic syndrome

.

Blood

.

2015

;

125

(

23

):

3637

-

3646

.

22.

Joly

BS

,

Coppo

P

,

Veyradier

A

.

Thrombotic thrombocytopenic purpura

.

Blood

.

2017

;

129

(

21

):

2836

-

2846

.

23.

Scully

M

,

Cataland

SR

,

Peyvandi

F

, et al.

Caplacizumab treatment for acquired thrombotic thrombocytopenic purpura

.

N Engl J Med

.

2019

;

380

(

4

):

335

-

346

.

24.

Subhan

M

,

Scully

M

.

Advances in the management of TTP

.

Blood Rev

.

2022

:

100945

.

25.

Coppo

P

,

Bubenheim

M

,

Azoulay

E

, et al.

A regimen with caplacizumab, immunosuppression, and plasma exchange prevents unfavorable outcomes in immune-mediated TTP

.

Blood

.

2021

;

137

(

2

):

733

-

742

.

26.

Bendapudi

PK

,

Hurwitz

S

,

Fry

A

, et al.

Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study

.

Lancet Haematol

.

2017

;

4

(

4

):

e157

-

e164

.

27.

Burguet

L

,

Taton

B

,

Prezelin-Reydit

M

, et al.

Urine protein/creatinine ratio in thrombotic microangiopathies: a simple test to facilitate thrombotic thrombocytopenic purpura and hemolytic and uremic syndrome diagnosis

.

J Clin Med

.

2022

;

11

(

3

):

648

.

28.

Fage

N

,

Orvain

C

,

Henry

N

, et al.

Proteinuria increases the PLASMIC and French scores performance to predict thrombotic thrombocytopenic purpura in patients with thrombotic microangiopathy syndrome

.

Kidney Int Rep

.

2022

;

7

(

2

):

221

-

231

.

29.

Liu

A

,

Dhaliwal

N

,

Upreti

H

, et al.

Reduced sensitivity of PLASMIC and French scores for the diagnosis of thrombotic thrombocytopenic purpura in older individuals

.

Transfusion

.

2021

;

61

(

1

):

266

-

273

.

30.

Milon

V

,

Fage

N

,

Guibert

F

,

Fremeaux-Bacchi

V

,

Augusto

JF

,

Brilland

B

.

Thrombotic microangiopathy with mild renal involvement and profound thrombocytopenia: not all roads lead to thrombotic thrombocytopenic purpura

.

J Nephrol

.

2022

;

35

(

4

):

1271

-

1273

.

31.

Fakhouri

F

,

Scully

M

,

Provot

F

, et al.

Management of thrombotic microangiopathy in pregnancy and postpartum: report from an international working group

.

Blood

.

2020

;

136

(

19

):

1271

-

1273

.

32.

El Karoui

K

,

Boudhabhay

I

,

Petitprez

F

, et al.

Impact of hypertensive emergency and complement rare variants on presentation and outcome of atypical hemolytic uremic syndrome

.

Haematologica

.

2019

;

104

(

12

):

2501

-

2511

.

33.

Cavero

T

,

Arjona

E

,

Soto

K

, et al.

Severe and malignant hypertension are common in primary atypical hemolytic uremic syndrome

.

Kidney Int

.

2019

;

96

(

4

):

995

-

1004

.

34.

Rubin

S

,

Cremer

A

,

Boulestreau

R

,

Rigothier

C

,

Kuntz

S

,

Gosse

P

.

Malignant hypertension: diagnosis, treatment and prognosis with experience from the Bordeaux cohort

.

J Hypertens

.

2019

;

37

(

2

):

316

-

324

.

35.

van den Born

BJ

,

Koopmans

RP

,

Groeneveld

JO

,

van Montfrans

GA

.

Ethnic disparities in the incidence, presentation and complications of malignant hypertension

.

J Hypertens

.

2006

;

24

(

11

):

2299

-

2304

.

36.

Larsen

CP

,

Wilson

JD

,

Best-Rocha

A

,

Beggs

ML

,

Hennigar

RA

.

Genetic testing of complement and coagulation pathways in patients with severe hypertension and renal microangiopathy

.

Mod Pathol

.

2018

;

31

(

3

):

488

-

494

.

37.

van den Born

BH

,

Lip

G.Y.H.

,

Brguljan-Hitij

J

, et al.

ESC Council on hypertension position document on the management of hypertensive emergencies

.

Eur Heart J Cardiovasc Pharmacother

.

2019

;

5

(

1

):

37

-

46

.

38.

Lane

DA

,

Lip

GY

,

Beevers

DG

.

Improving survival of malignant hypertension patients over 40 years

.

Am J Hypertens

.

2009

;

22

(

11

):

1199

-

1204

.

39.

Lip

GY

,

Beevers

M

,

Beevers

DG

.

Complications and survival of 315 patients with malignant-phase hypertension

.

J Hypertens

.

1995

;

13

(

8

):

915

-

924

.

40.

Shantsila

A

,

Shantsila

E

,

Beevers

DG

,

Lip

G.Y.H.

.

Predictors of 5-year outcomes in malignant phase hypertension: the West Birmingham Malignant Hypertension Registry

.

J Hypertens

.

2017

;

35

(

5

):

2310

-

2314

.

41.

Merinero

HM

,

Garcia

SP

,

Garcia-Fernandez

J

,

Arjona

E

,

Tortajada

A

,

Rodriguez de Cordoba

S

.

Complete functional characterization of disease-associated genetic variants in the complement factor H gene

.

Kidney Int

.

2018

;

93

(

2

):

470

-

481

.

42.

Fakhouri

F

,

Fremeaux-Bacchi

V

.

Thrombotic microangiopathy in aHUS and beyond: clinical clues from complement genetics

.

Nat Rev Nephrol

.

2021

;

17

(

8

):

543

-

553

.

43.

Licht

C

,

Greenbaum

LA

,

Muus

P

, et al.

Efficacy and safety of eculizumab in atypical hemolytic uremic syndrome from 2-year extensions of phase 2 studies

.

Kidney Int

.

2015

;

87

(

5

):

1061

-

1073

.

44.

Fakhouri

F

,

Delmas

Y

,

Provot

F

, et al.

Insights from the use in clinical practice of eculizumab in adult patients with atypical hemolytic uremic syndrome affecting the native kidneys: an analysis of 19 cases

.

Am J Kidney Dis

.

2014

;

63

(

1

):

40

-

48

.

45.

Menne

J

,

Delmas

Y

,

Fakhouri

F

, et al.

Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study

.

BMC Nephrol

.

2019

;

20

(

1

):

125

.

46.

Rondeau

E

,

Scully

M

,

Ariceta

G

, et al.

The long-acting C5 inhibitor, ravulizumab, is effective and safe in adult patients with atypical hemolytic uremic syndrome naive to complement inhibitor treatment

.

Kidney Int

.

2020

;

97

(

6

):

1287

-

1296

.

47.

Fakhouri

F

,

Fila

M

,

Provot

F

, et al.

Pathogenic variants in complement genes and risk of atypical hemolytic uremic syndrome relapse after eculizumab discontinuation

.

Clin J Am Soc Nephrol

.

2017

;

12

(

1

):

50

-

59

.

48.

Sheerin

NS

,

Kavanagh

D

,

Goodship

TH

,

Johnson

S

.

A national specialized service in England for atypical haemolytic uraemic syndrome-the first year’s experience

.

QJM

.

2016

;

109

(

1

):

27

-

33

.

49.

Ardissino

G

,

Possenti

I

,

Tel

F

,

Testa

S

,

Salardi

S

,

Ladisa

V

.

Discontinuation of eculizumab treatment in atypical hemolytic uremic syndrome: an update

.

Am J Kidney Dis

.

2015

;

66

(

1

):

172

-

173

.

50.

Wetzels

JF

,

van de Kar

NC

.

Discontinuation of eculizumab maintenance treatment for atypical hemolytic uremic syndrome

.

Am J Kidney Dis

.

2015

;

65

(

2

):

342

.

51.

Merrill

SA

,

Brittingham

ZD

,

Yuan

X

,

Moliterno

AR

,

Sperati

CJ

,

Brodsky

RA

.

Eculizumab cessation in atypical hemolytic uremic syndrome

.

Blood

.

2017

;

130

(

3

):

368

-

372

.

52.

Wijnsma

KL

,

Duineveld

C

,

Volokhina

EB

,

van den Heuvel

LP

,

van de Kar

N

,

Wetzels

J.F.M.

.

Safety and effectiveness of restrictive eculizumab treatment in atypical haemolytic uremic syndrome

.

Nephrol Dial Transplant

.

2017

;

33

(

4

):

635

-

645

.

53.

Fakhouri

F

,

Fila

M

,

Hummel

A

, et al.

Eculizumab discontinuation in children and adults with atypical haemolytic uremic syndrome: a prospective multicentric study

.

Blood

.

2021

;

137

(

18

):

2439

-

2449

.

54.

Brambilla

M

,

Ardissino

G

,

Paglialonga

F

,

Testa

S

,

Capone

V

,

Montini

G

.

Haemoglobinuria for the early identification of aHUS relapse: data from the ItalKId-HUS Network

.

J Nephrol

.

2022

;

35

(

1

):

279

-

284

.

55.

Gatault

P

,

Brachet

G

,

Ternant

D

, et al.

Therapeutic drug monitoring of eculizumab: Rationale for an individualized dosing schedule

.

MAbs

.

2015

;

7

(

6

):

1205

-

1211

.

56.

Cugno

M

,

Gualtierotti

R

,

Possenti

I

, et al.

Complement functional tests for monitoring eculizumab treatment in patients with atypical hemolytic uremic syndrome

.

J Thromb Haemost

.

2014

;

12

(

9

):

1440

-

1448

.

57.

Bruel

A

,

Kavanagh

D

,

Noris

M

, et al.

Hemolytic uremic syndrome in pregnancy and postpartum

.

Clin J Am Soc Nephrol

.

2017

;

12

(

8

):

1237

-

1247

.

58.

Cravero

R

,

Ardissino

G

,

Colageo

U

, et al.

Efficacy of eculizumab in a case of pregnancy-associated aHUS [in Italian]

.

G Ital Nefrol

.

2016

;

33

(

4

):

gin/33.4.14

.

59.

Canigral

C

,

Moscardo

F

,

Castro

C

, et al.

Eculizumab for the treatment of pregnancy-related atypical hemolytic uremic syndrome

.

Ann Hematol

.

2014

;

93

(

8

):

1421

-

1422

.

60.

De Sousa Amorim

E

,

Blasco

M

,

Quintana

L

,

Sole

M

,

de Cordoba

SR

,

Campistol

JM

.

Eculizumab in pregnancy-associated atypical hemolytic uremic syndrome: insights for optimizing management

.

J Nephrol

.

2015

;

28

(

5

):

641

-

645

.

61.

Gately

R

,

San

A

,

Kurtkoti

J

,

Parnham

A

.

Life-threatening pregnancy-associated atypical haemolytic uraemic syndrome and its response to eculizumab

.

Nephrology

.

2017

;

22

(

suppl 1

):

32

-

35

.

62.

Huerta

A

,

Arjona

E

,

Portoles

J

, et al.

A retrospective study of pregnancy-associated atypical hemolytic uremic syndrome

.

Kidney Int

.

2018

;

93

(

2

):

450

-

459

.

63.

Mandala

EMGS

,

Kasimatis

E

,

Lafaras

C

, et al.

Pregnancy-associated atypical hemolytic uremic syndrome (aHUS), treated with eculizumab

.

Blood

.

2014

;

124

(

21

):

5019

.

64.

Saad

AF

,

Roman

J

,

Wyble

A

,

Pacheco

LD

.

Pregnancy-associated atypical hemolytic-uremic syndrome

.

AJP Rep

.

2016

;

6

(

1

):

e125

-

e128

.

65.

Shanmugalingam

R

,

Hsu

D

,

Makris

A

.

Pregnancy-induced atypical haemolytic uremic syndrome: a new era with eculizumab

.

Obstet Med

.

2018

;

11

(

1

):

28

-

31

.

66.

Socie

G

,

Caby-Tosi

MP

,

Marantz

JL

, et al.

Eculizumab in paroxysmal nocturnal haemoglobinuria and atypical haemolytic uraemic syndrome: 10-year pharmacovigilance analysis

.

Br J Haematol

.

2019

;

185

(

2

):

297

-

310

.

67.

Kelly

RJ

,

Hochsmann

B

,

Szer

J

, et al.

Eculizumab in pregnant patients with paroxysmal nocturnal hemoglobinuria

.

N Engl J Med

.

2015

;

373

(

11

):

1032

-

1039

.

68.

Servais

A

,

Devillard

N

,

Fremeaux-Bacchi

V

, et al.

Atypical haemolytic uraemic syndrome and pregnancy: outcome with ongoing eculizumab

.

Nephrol Dial Transplant

.

2016

;

31

(

12

):

2122

-

2130

.

69.

Rondeau

E

,

Ardissino

G

,

Caby-Tosi

MP

, et al.

Pregnancy in women with atypical hemolytic uremic syndrome

.

Nephron

.

2022

;

146

(

1

):

1

-

10

.

70.

Turley

AJ

,

Gathmann

B

,

Bangs

C

, et al.

Spectrum and management of complement immunodeficiencies (excluding hereditary angioedema) across Europe

.

J Clin Immunol

.

2015

;

35

(

2

):

199

-

205

.

71.

Ladhani

SN

,

Campbell

H

,

Lucidarme

J

, et al.

Invasive meningococcal disease in patients with complement deficiencies: a case series (2008-2017)

.

BMC Infect Dis

.

2019

;

19

(

1

):

522

.

72.

Rosain

J

,

Hong

E

,

Fieschi

C

, et al.

Strains responsible for invasive meningococcal disease in patients with terminal complement pathway deficiencies

.

J Infect Dis

.

2017

;

215

(

8

):

1331

-

1338

.

73.

Gackler

A

,

Kaulfuss

M

,

Rohn

H

, et al.

Failure of first meningococcal vaccination in patients with atypical haemolytic uraemic syndrome treated with eculizumab

.

Nephrol Dial Transplant

.

2020

;

35

(

2

):

298

-

303

.

74.

Martinon-Torres

F

,

Bernatowska

E

,

Shcherbina

A

, et al.

Meningococcal B vaccine immunogenicity in children with defects in complement and splenic function

.

Pediatrics

.

2018

;

142

(

3

):

e20174250

.

75.

Langereis

JD

,

van den Broek

B

,

Franssen

S

, et al.

Eculizumab impairs Neisseria meningitidis serogroup B killing in whole blood despite 4CMenB vaccination of PNH patients

.

Blood Adv

.

2020

;

4

(

15

):

3615

-

3620

.

76.

Reher

D

,

Fuhrmann

V

,

Kluge

S

,

Nierhaus

A

.

A rare case of septic shock due to Neisseria meningitidis serogroup B infection despite prior vaccination in a young adult with paroxysmal nocturnal haemoglobinuria receiving eculizumab

.

Vaccine

.

2018

;

36

(

19

):

2507

-

2509

.

77.

Parikh

SR

,

Lucidarme

J

,

Bingham

C

, et al.

Meningococcal B vaccine failure with a penicillin-resistant strain in a young adult on long-term eculizumab

.

Pediatrics

.

2017

;

140

(

3

):

e20162452

.

78.

Crew

PE

,

Abara

WE

,

McCulley

L

, et al.

Disseminated gonococcal infections in patients receiving eculizumab: a case series

.

Clin Infect Dis

.

2019

;

69

(

4

):

596

-

600

.

79.

Shears

A

,

Steele

C

,

Craig

J

, et al.

Clinical outcome and underlying genetic cause of functional terminal complement pathway deficiencies in a multicenter UK cohort

.

J Clin Immunol

.

2022

;

42

(

3

):

665

-

671

.

80.

Cugno

M

,

Berra

S

,

Depetri

F

, et al.

IgM autoantibodies to complement factor H in atypical hemolytic uremic syndrome

.

J Am Soc Nephrol

.

2021

;

32

(

5

):

1227

-

1235

.

81.

Holmes

LV

,

Strain

L

,

Staniforth

SJ

, et al.

Determining the population frequency of the CFHR3/CFHR1 deletion at 1q32

.

PLoS One

.

2013

;

8

(

4

):

e60352

.

82.

Rigothier

C

,

Delmas

Y

,

Roumenina

LT

, et al.

Distal angiopathy and atypical hemolytic uremic syndrome: clinical and functional properties of an anti-factor H IgAλ antibody

.

Am J Kidney Dis

.

2015

;

66

(

2

):

331

-

336

.

83.

Dragon-Durey

MA

,

Sethi

SK

,

Bagga

A

, et al.

Clinical features of anti-factor H autoantibody-associated hemolytic uremic syndrome

.

J Am Soc Nephrol

.

2010

;

21

(

12

):

2180

-

2187

.

84.

Zuber

J

,

Frimat

M

,

Caillard

S

, et al.

Use of highly individualized complement blockade has revolutionized clinical outcomes after kidney transplantation and renal epidemiology of atypical hemolytic uremic syndrome

.

J Am Soc Nephrol

.

2019

;

30

(

12

):

2449

-

2463

.

85.

Le Quintrec

M

,

Lionet

A

,

Kamar

N

, et al.

Complement mutation-associated de novo thrombotic microangiopathy following kidney transplantation

.

Am J Transplant

.

2008

;

8

(

8

):

1694

-

1701

.

86.

Jodele

S

,

Laskin

BL

,

Dandoy

CE

, et al.

A new paradigm: diagnosis and management of HSCT-associated thrombotic microangiopathy as multi-system endothelial injury

.

Blood Rev

.

2015

;

29

(

11

):

191

-

204

.

87.

Le Quintrec

M

,

Zuber

J

,

Moulin

B

, et al.

Complement genes strongly predict recurrence and graft outcome in adult renal transplant recipients with atypical hemolytic and uremic syndrome

.

Am J Transplant

.

2013

;

13

(

3

):

663

-

675

.

88.

Duineveld

C

,

Verhave

JC

,

Berger

SP

,

van de Kar

N

,

Wetzels

J.F.M.

.

Living donor kidney transplantation in atypical hemolytic uremic syndrome: a case series

.

Am J Kidney Dis

.

2017

;

70

(

6

):

770

-

777

.

89.

Ueda

Y

,

Miwa

T

,

Ito

D

, et al.

Differential contribution of C5aR and C5b-9 pathways to renal thrombic microangiopathy and macrovascular thrombosis in mice carrying an atypical hemolytic syndrome-related factor H mutation

.

Kidney Int

.

2019

;

96

(

1

):

67

-

79

.

90.

Risitano

AM

,

Roth

A

,

Soret

J

, et al.

Addition of iptacopan, an oral factor B inhibitor, to eculizumab in patients with paroxysmal nocturnal haemoglobinuria and active haemolysis: an open-label, single-arm, phase 2, proof-of-concept trial

.

Lancet Haematol

.

2021

;

8

(

5

):

e344

-

e354

.

91.

Hillmen

P

,

Szer

J

,

Weitz

I

, et al.

Pegcetacoplan versus eculizumab in paroxysmal nocturnal hemoglobinuria

.

N Engl J Med

.

2021

;

384

(

11

):

1028

-

1037

.

92.

Risitano

AM

,

Marotta

S

,

Ricci

P

, et al.

Anti-complement treatment for paroxysmal nocturnal hemoglobinuria: time for proximal complement inhibition? A position paper from the SAAWP of the EBMT

.

Front Immunol

.

2019

;

10

:

1157

.

93.

Gorzynski

JE

,

Goenka

SD

,

Shafin

K

, et al.

Ultrarapid nanopore genome sequencing in a critical care setting

.

N Engl J Med

.

2022

;

386

(

7

):

700

-

702

.