THE RELATIONSHIP OF CURRENT TRANSFUSION PRACTICE TO MODERN IMMUNOHEMATOEOGY

An association between thalassaemia and autoimmune haemolytic anaemia (AIHA)

An association between thalassaemia and autoimmune haemolytic anaemia (AIHA) has not been previously recognized. 10 patients with thalassaemic diseases were found to give positive results to antiglobulin test with polyvalent antiserum. Tests with monovalent antisera revealed immunoglobulins on the red cells in all cases. From history of blood transfusion, auto-antibodies following alloimmunization were very unlikely. IgG, either alone or together with IgM or IgA, was the predominant antibody on the red cells. All cases had warm type AIHA and responded dramatically well with steroid treatment except 3 who eventually needed splenectomy which responded in 2 and failed in 1.

Critical re-examination of the specificity of auto-anti-Rh antibodies in patients with a positive direct antiglobulin test

Forty-eight autoantibodies with apparent 'simple' anti-Rh specificity (anti-e, -E, -c, -D, -C, -Ce, -G), have been studied by means of multiple absorption tests. The finding that 34 (70.8%) of these antibodies could bind to red blood cells lacking the antigens that the antibodies appeared to define, indicated that the antibodies had different specificities than seemed to be the case in initial antibody identification tests. Those autoantibodies that at first appeared to be directed against the Rh antigens e, E or c, most often had anti-Hr or anti-Hro specificity. These data explain why some apparent anti-Rh autoantibodies can be eluted from the red blood cells of patients negative for the antigens that the antibodi:s appear to define. However, they also illustrate that the phenomenon of autoantibodies mimicking specificities that they do not possess is common in patients positive for the antigens against which their autoantibodies appear to be directed. An explanation for the mode of action of these autoantibodies in complexing with the Rh agglutinogen is proposed, and the significance of the antibodies in transfusion therapy is considered.