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McKnight TF, DiGuardo MA, Jacob EK. New Developments in the Understanding and Treatment of Autoimmune Hemolytic Anemia: Traditional and Novel Tests. Hematol Oncol Clin North Am 2022; 36:293-305. [DOI: 10.1016/j.hoc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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2
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Ladogana S, Maruzzi M, Samperi P, Perrotta S, Del Vecchio GC, Notarangelo LD, Farruggia P, Verzegnassi F, Masera N, Saracco P, Fasoli S, Miano M, Girelli G, Barcellini W, Zanella A, Russo G. Diagnosis and management of newly diagnosed childhood autoimmune haemolytic anaemia. Recommendations from the Red Cell Study Group of the Paediatric Haemato-Oncology Italian Association. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:259-267. [PMID: 28151390 PMCID: PMC5448833 DOI: 10.2450/2016.0072-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 11/09/2016] [Indexed: 01/20/2023]
Abstract
Autoimmune haemolytic anaemia is an uncommon disorder to which paediatric haematology centres take a variety of diagnostic and therapeutic approaches. The Red Cell Working Group of the Italian Association of Paediatric Onco-haematology (Associazione Italiana di Ematologia ed Oncologia Pediatrica, AIEOP) developed this document in order to collate expert opinions on the management of newly diagnosed childhood autoimmune haemolytic anaemia.The diagnostic process includes the direct and indirect antiglobulin tests; recommendations are given regarding further diagnostic tests, specifically in the cases that the direct and indirect antiglobulin tests are negative. Clear-cut definitions of clinical response are stated. Specific recommendations for treatment include: dosage of steroid therapy and tapering modality for warm autoimmune haemolytic anaemia; the choice of rituximab as first-line therapy for the rare primary transfusion-dependent cold autoimmune haemolytic anaemia; the indications for supportive therapy; the need for switching to second-line therapy. Each statement is provided with a score expressing the level of appropriateness and the agreement among participants.
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Affiliation(s)
- Saverio Ladogana
- Paediatric Onco-haematology Unit, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Matteo Maruzzi
- Paediatric Onco-haematology Unit, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Piera Samperi
- Paediatric Onco-haematology Unit, Azienda Policlinico “Vittorio Emanuele”, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silverio Perrotta
- Department of Women, Children and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | | | - Lucia D. Notarangelo
- Paediatric Onco-haematology Unit, Children’s Hospital, Spedali Civili, Brescia, Italy
| | - Piero Farruggia
- Paediatric Onco-haematology Unit, Civico Hospital, Palermo, Italy
| | | | - Nicoletta Masera
- Paediatric Department, University of Milano-Bicocca, “San Gerardo” Hospital, Monza, Italy
| | - Paola Saracco
- Paediatric and Adolescent Science Department, University of Turin, Turin, Italy
| | - Silvia Fasoli
- Paediatric Unit, “Carlo Poma” Hospital, Mantua, Italy
| | - Maurizio Miano
- Clinical and Experimental Haematology Unit, “G. Gaslini” Children’s Hospital, Genoa, Italy
| | - Gabriella Girelli
- Immunohaematology and Transfusion Medicine Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Wilma Barcellini
- Onco-haematology, Physiopathology of Anaemia Unit, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zanella
- Onco-haematology, Physiopathology of Anaemia Unit, IRCCS Ca’ Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Russo
- Paediatric Onco-haematology Unit, Azienda Policlinico “Vittorio Emanuele”, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Paper-based assay for red blood cell antigen typing by the indirect antiglobulin test. Anal Bioanal Chem 2016; 408:5231-8. [PMID: 27185543 DOI: 10.1007/s00216-016-9617-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/20/2016] [Accepted: 05/02/2016] [Indexed: 12/11/2022]
Abstract
A rapid and simple paper-based elution assay for red blood cell antigen typing by the indirect antiglobulin test (IAT) was established. This allows to type blood using IgG antibodies for the important blood groups in which IgM antibodies do not exist. Red blood cells incubated with IgG anti-D were washed with saline and spotted onto the paper assay pre-treated with anti-IgG. The blood spot was eluted with an elution buffer solution in a chromatography tank. Positive samples were identified by the agglutinated and fixed red blood cells on the original spotting area, while red blood cells from negative samples completely eluted away from the spot of origin. Optimum concentrations for both anti-IgG and anti-D were identified to eliminate the washing step after the incubation phase. Based on the no-washing procedure, the critical variables were investigated to establish the optimal conditions for the paper-based assay. Two hundred ten donor blood samples were tested in optimal conditions for the paper test with anti-D and anti-Kell. Positive and negative samples were clearly distinguished. This assay opens up new applications of the IAT on paper including antibody detection and blood donor-recipient crossmatching and extends its uses into non-blood typing applications with IgG antibody-based diagnostics. Graphical abstract A rapid and simple paper-based assay for red blood cell antigen typing by the indirect antiglobulin test.
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Packman CH. The Clinical Pictures of Autoimmune Hemolytic Anemia. Transfus Med Hemother 2015; 42:317-24. [PMID: 26696800 PMCID: PMC4678314 DOI: 10.1159/000440656] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022] Open
Abstract
Autoimmune hemolytic anemia is characterized by shortened red blood cell survival and a positive Coombs test. The responsible autoantibodies may be either warm reactive or cold reactive. The rate of hemolysis and the severity of the anemia may vary from mild to severe and life-threatening. Diagnosis is made in the laboratory by the findings of anemia, reticulocytosis, a positive Coombs test, and specific serologic tests. The prognosis is generally good but renal failure and death sometimes occur, especially in cases mediated by drugs.
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Affiliation(s)
- Charles H Packman
- Department of Hematology, Levine Cancer Institute, University of North Carolina School of Medicine, Carolinas Healthcare System, Charlotte, NC, USA
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5
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Lai M, De Stefano V, Landolfi R. Haemoglobin levels in autoimmune haemolytic anaemias at diagnosis: relationship with immunoproteins on red blood cells. Immunol Res 2015; 60:127-31. [PMID: 24619312 DOI: 10.1007/s12026-014-8497-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Previous investigations of the relationship between characteristics of immunoproteins on red blood cells (RBCs) and the occurrence of autoimmune haemolysis yielded divergent results. Here, we studied these characteristics in autoimmune haemolytic anaemias (AIHAs) to determine their relationship with the degree of anaemia at diagnosis. We studied at diagnosis 52 cases of warm AIHA with positive direct antiglobulin test. Immunohaematological testing and determination of immunoglobulin class, complement, and immunoglobulin G (IgG) were performed using gel technology (GCT). Median haemoglobin (Hb) levels significantly differed between cases with IgG1 only or negative for IgG subclasses (7.4 g/dl), those with IgG3 or IgG1 + IgG3 (6.5 g/dl), and those with multiple immunoglobulins (5 g/dl). Logistic regression indicated that IgG3 detection was the only variable significantly related to the occurrence of RBC transfusion in AIHA (odds ratio 4.05, 95 % CI 1.1-14.7). In our study, the type of immunoprotein(s) on the RBC surface was associated with different Hb levels at AIHA diagnosis. IgG3 and multiple immunoglobulins were associated with lower Hb levels; IgG3 was also associated with a higher percentage of patient transfusions in the first week after diagnosis. Thus, qualitative differences in these immunoproteins may lead to deeper and more prolonged anaemia levels, influencing the need for RBC transfusion.
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Affiliation(s)
- Marco Lai
- Transfusion Centre, Institute of Hematology, Catholic University, Rome, Italy,
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Segel GB, Lichtman MA. Direct antiglobulin (“Coombs”) test-negative autoimmune hemolytic anemia: A review. Blood Cells Mol Dis 2014; 52:152-60. [DOI: 10.1016/j.bcmd.2013.12.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 11/27/2022]
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7
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Lai M, Leone G, Landolfi R. Autoimmune hemolytic anemia with gel-based immunohematology tests. Am J Clin Pathol 2013; 139:457-63. [PMID: 23525616 DOI: 10.1309/ajcptu9aeqzxvzd4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We used gel centrifugation tests (GCTs) to analyze the relationship between the diagnosis and immunohematology tests used for autoimmune hemolytic anemia (AIHA). The study included 588 samples positive for the direct antiglobulin test (DAT). Of these, 52 were from patients diagnosed with AIHA. Immunoglobulin (Ig) class, IgG1, IgG3, and complement were measured. DAT strength had the strongest correlation with AIHA diagnosis (odds ratio [OR], 23), followed by anti-IgG titer 300 (OR, 8.4), anti-IgG titer 1,000 (OR, 10.5), and C3d agglutination strength (OR, 1.7). Decision tree analysis revealed that DAT strength and anti-IgG titer higher than 100 were the best predictors of AIHA. Multidimensional scanning analysis found a high grade of similarity among DAT strength, anti-IgG titer, and IgG strength in the AIHA samples. This observation was not detected in DAT-positive samples from patients without AIHA. DAT strength remained the best diagnostic indicator for AIHA and had the strongest association with AIHA compared with other commercially available immunohematology tests. The other tests, despite good correlation with AIHA diagnosis, did not add useful information.
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Affiliation(s)
- Marco Lai
- Immunohematology Laboratory, Transfusion Centre, Catholic University of Sacred Heart, Rome, Italy
| | - Giuseppe Leone
- Institute of Hematology Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Raffaele Landolfi
- Internal Medicine Department, Catholic University of Sacred Heart, Rome, Italy
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Rosse WF. Quantitative immunology of immune hemolytic anemia: II. The relationship of cell-bound antibody to hemolysis and the effect of treatment. J Clin Invest 2010; 50:734-43. [PMID: 16695957 PMCID: PMC291987 DOI: 10.1172/jci106544] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The concentration of cell-bound and serum antibody was determined in a series of patients with warm antibody immune hemolytic anemia by determining the amount of C[unk]1 fixed to the cells by anti-IgG. This was compared to the rate of hemolysis as determined by hemoglobin concentration and reticulocyte count, or the endogenous production of carbon monoxide. The rate of hemolysis was, in general, proportional to the concentration of cell-bound antibody. In splenectomized patients, the rate of hemolysis was very much less than in unsplenectomized patients for a given concentration of cell-bound antibody. When prednisone was given, three effects were noted: (a) at high doses of drug, the concentration of cell-bound antibody decreased rapidly and the concentration of serum antibody increased, suggesting that the affinity of antibody for antigen had been altered; (b) in patients achieving remission, the concentration of serum antibody fell to low levels but rose again if the dose of prednisone was insufficient; (c) in one patient, prednisone appeared to inhibit sequestration of highly sensitized cells.
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Affiliation(s)
- W F Rosse
- Duke University Medical Center, Durham, North Carolina 27706
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Barcellini W, Revelli N, Imperiali FG, Villa MA, Manera MC, Paccapelo C, Zaninoni A, Zanella A. Comparison of traditional methods and mitogen-stimulated direct antiglobulin test for detection of anti-red blood cell autoimmunity. Int J Hematol 2010; 91:762-9. [DOI: 10.1007/s12185-010-0578-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 04/13/2010] [Accepted: 04/15/2010] [Indexed: 11/30/2022]
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Shvidel L, Shtalrid M, Duek A, Haran M, Berrebi A, Sigler E. Direct antiglobulin test reactive with complement only in warm type autoimmune hemolytic anemia. Int J Lab Hematol 2009; 30:494-8. [PMID: 18983301 DOI: 10.1111/j.1751-553x.2007.00985.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Direct antiglobulin test (DAT) with only complement detected on red blood cells is a rare laboratory finding, and its significance in the setting of warm autoimmune hemolytic anemia (AIHA) is controversial. During 2 years (2003-2004) 277 patients with positive DAT were recorded in the blood bank registries, 17 of them had DAT reactive with C3 alone with no cold agglutinin or other nonimmune causes for hemolysis diagnosed. Red cell eluate disclosed small amounts of IgG in two patients. In nine patients no signs of clinical hemolysis were found, however, all these patients had underlying conditions that are known to be associated with red cells autoantibodies (autoimmune disorder or malignancy). Eight patients developed AIHA, seven of them with severe hemolysis. Three patients had idiopathic AIHA, and the others have been diagnosed with infectious, lymphoproliferative and autoimmune disorders. In two patients with acute infection the hemolytic process spontaneously resolved, three responded to corticosteroid therapy, while three patients were refractory to two lines of drug therapy and underwent splenectomy. Reticulocytopenia was found in four patients. Our results emphasize that AIHA with DAT reactive with complement alone is a rare disorder and might be accompanied by severe, refractory to conventional treatment and life-threatening hemolysis.
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Affiliation(s)
- L Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, affiliated to Hebrew University and Hadassah Medical School, Jerusalem, Israel
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Lin JS, Hao TC, Lyou JY, Chen YJ, Liu HM, Tzeng CH, Chiou TJ. Clinical application of a flow cytometric direct antiglobulin test. Transfusion 2009; 49:1335-46. [PMID: 19320864 DOI: 10.1111/j.1537-2995.2009.02130.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The clinical application of flow cytometric direct antiglobulin test (FC-DAT) has rarely been evaluated for patients with various diseases including immune and nonimmune hemolytic anemia. STUDY DESIGN AND METHODS Blood samples from 380 patients with a variety of diseases were studied using the tube direct DAT and FC-DAT. The results of tube DAT and FC-DAT were compared. The predictive values of DAT for hemolysis were evaluated. RESULTS Of 57 patients with autoimmune hemolytic anemia (AIHA), 6 of the 17 with a negative tube DAT (immunoglobulin G [IgG]) had a positive FC-DAT (IgG) and 23 of the 36 patients with a negative tube DAT (complement 3d [C3d]) had a positive FC-DAT (C3d). In 57 patients with AIHA, the incidence of positive results of FC-DAT (IgG) and tube DAT (IgG) were similar (42 positive vs. 40 positive); but in 323 patients without AIHA, the incidence of positive FC-DATs (IgG) was higher than that of tube DAT (IgG; 47 positive vs. 9 positive). The higher incidence of positive FC-DAT (C3d) than that of tube DAT (C3d) was seen in patients with AIHA (42 positive vs. 21 positive) as well as in patients without AIHA (61 positive vs. 5 positive). Both DAT (IgG) and DAT (C3d) positive has highest positive predictive value for hemolysis, followed by DAT (IgG) alone positive and DAT (C3d) alone positive. CONCLUSIONS FC-DAT is a complementary test for diagnosing AIHA. There is a synergistic effect of the red blood cell-bound IgG and complement in predicting hemolysis.
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Affiliation(s)
- Jeong-Shi Lin
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, No. 201 Section 2 Shih-Pai Road, Taipei, Taiwan.
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Kamesaki T, Oyamada T, Omine M, Ozawa K, Kajii E. Cut-off value of red-blood-cell-bound IgG for the diagnosis of Coombs-negative autoimmune hemolytic anemia. Am J Hematol 2009; 84:98-101. [PMID: 19105232 DOI: 10.1002/ajh.21336] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Direct antiglobulin test (DAT)-negative autoimmune hemolytic anemia (Coombs-negative AIHA) is characterized by laboratory evidence of in vivo hemolysis, together with a negative DAT performed by conventional tube technique (CTT) in clinically suspected AIHA patients. The immunoradiometric assay (IRMA) for red-blood-cell-bound immunoglobulin G (RBC-IgG) can be used to diagnose patients in whom CTT does not detect low levels of red cell autoantibodies. We investigated the diagnostic cutoff value of the IRMA for RBC-IgG in Coombs-negative AIHA and calculated its sensitivity and specificity. Of the 140 patients with negative DAT by CTT referred to our laboratory with undiagnosed hemolytic anemia, AIHA was clinically diagnosed in 64 patients (Coombs-negative AIHA). The numbers of Coombs-negative AIHA and non-AIHA patients changed with age and gender. The cutoff values were determined from receiver operating characteristic (ROC) curve according to age and gender. The IRMA for RBC-IgG proved to be sensitive (71.4%) and specific (87.8%) when using these cutoffs. Using these cutoffs for 41 patients with negative DAT referred to our laboratory in 2006, all the pseudonegative cases were treated with steroids before the test. The 31 untreated cases could be grouped using one cutoff value of 78.5 and showed 100% sensitivity and 94% specificity, independent of gender and age. Results indicate that RBC-IgG could become a standard approach for the diagnosis of Coombs-negative AIHA, when measured before treatment.
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MESH Headings
- Adolescent
- Adrenal Cortex Hormones/pharmacology
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Area Under Curve
- Artifacts
- Autoantibodies/blood
- Child
- Child, Preschool
- Coombs Test/methods
- Erythrocyte Membrane/immunology
- False Negative Reactions
- Female
- Follow-Up Studies
- Humans
- Immunoglobulin G/blood
- Immunoradiometric Assay
- Immunosuppressive Agents/pharmacology
- Immunosuppressive Agents/therapeutic use
- Infant
- Male
- Middle Aged
- ROC Curve
- Sensitivity and Specificity
- Sex Factors
- Young Adult
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Affiliation(s)
- Toyomi Kamesaki
- Center for Community Medicine, Jichi Medical University, Tochigi, Japan.
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Abstract
The diagnosis of autoimmune hemolytic anemia (AHA) requires evidence of shortened red blood cell (RBC) survival mediated by autoantibodies directed against autologous RBCs. About 80 percent of patients with AHA have warm-reactive antibodies of the IgG isotype; the remainder exhibit cold-reactive autoantibodies. Typical patients exhibit anemia, reticulocytosis, spherocytes and polychromasia on the blood film and a positive direct antiglobulin test (DAT). Increased indirect serum bilirubin, urinary urobilinogen and serum lactate dehydrogenase (LDH), and decreased serum haptoglobin are not required for the diagnosis, but are frequently present. Patients with AHA and no underlying associated disease are said to have primary or idiopathic AHA. AHA in patients with associated autoimmune disease and certain malignant or infectious diseases is classified as secondary. The etiology of AHA is unknown. Patients with symptomatic anemia require transfusion of RBCs. Prednisone and splenectomy may provide long term remission. Rituximab, intravenous immunoglobulin, immunosuppressive drugs and danazol have been effective in refractory cases and for patients who are poor candidates for surgery.
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Affiliation(s)
- Charles H Packman
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
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Abstract
Immune hemolytic anemia can occur in patients who have no antibodies detectable by routine procedures (direct [DAT] and indirect [IAT] antiglobulin tests). DAT-negative autoimmune hemolytic anemias (AIHAs) represent 5% to 10% of all AIHAs. Three causes have been identified: (1) small numbers of red blood cell (RBC)-bound IgG molecules below the threshold of the DAT; (2) IgA and IgM autoantibodies; and (3) low-affinity autoantibodies. Antibody-independent cytotoxic events caused by natural killer (NK) cells have also been implicated. DATs are sometimes found to be positive when tested by reference laboratories, due to poor technique in reading antiglobulin tests in hospital laboratories. Hemolytic transfusion reactions also can occur when no alloantibodies are detectable by routine procedures. In some cases antibodies can be detected by special serologic procedures (such as the Polybrene test); in other instances phenotypically matched RBCs survive well and a specific antigen can be shown to be involved, suggesting a specificity (like anti-C) that is undetectable by any technique. Antibodies other than to blood group antigens, such as human leukocyte antigen (HLA) antibodies, may sometimes be involved.
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16
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Price TH, Sayers MH, Gilliland BC. IMMUNOHEMATOLOGY. Immunol Allergy Clin North Am 1994. [DOI: 10.1016/s0889-8561(22)00783-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Haematological involvement is common in systemic lupus erythematosus (SLE). Whilst anaemia is most often due to chronic disease, other causes such as autoimmune haemolytic anaemia and hypoplastic anaemia need to be considered. The increased risk of infection in patients with SLE is due in part to changes in the white blood cells though treatments do not yet aim to modify these. Thrombocytopenia occurs frequently and is almost invariably autoimmune. It is often of little consequence, but may occasionally be severe and serious, requiring aggressive treatment. Patients with SLE have an increased risk of thrombosis, increased further in the presence of antiphospholipid antibodies (aPL). Changes in the haemostatic system and new insights into the nature of aPL are described.
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Affiliation(s)
- D M Keeling
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
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Detection of red cell sensitisation by antibody and complement: Current practice and future perspectives. ACTA ACUST UNITED AC 1993. [DOI: 10.1007/bf02341967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Hemolysis can be induced by two general mechanisms. In the first one, erythrocytes lyse intravascularly due to complement fixation, trauma, or other extrinsic factors. In the second mechanism, which is the most common, the red cells are removed from the circulation by the mononuclear-phagocytic system either because they are intrinsically defective or because of the presence of bound immunoglobulins to their surfaces. The diagnosis of hemolysis is not difficult to establish and is based on the presence of anemia with sustained reticulocytosis in the absence of blood loss. Additional findings can include marrow erythroid hyperplasia; increased unconjugated bilirubin, LDH, and free hemoglobin; decreased haptoglobin and hemopexin; hemoglobinuria and hemosiderinuria; and decreased 51Cr red cell half-life. Hemoglobinemia, hemoglobinuria, and hemosiderinuria occur only in the setting of severe and rapid intravascular hemolysis. Conditions associated with significant lysis of red cells in the circulation include incompatible transfusion, G6PD deficiency, PNH, severe burns, and certain infections. The morphology of the red cell is abnormal in almost all cases of hemolytic anemia. However, the morphologic abnormality can be, in certain cases, diagnostic of the underlying condition. Treatment is usually supportive, with effective therapy directed to treat the underlying cause of hemolysis.
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Affiliation(s)
- I A Tabbara
- Department of Internal Medicine, George Washington University Medical Center, Washington, DC
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20
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Giles CM, Davies KA, Loizou S, Moulds JJ, Walport MJ. Quantification of IgG on erythrocytes of patients and normals by a radio-ligand-binding assay. Transfus Med 1991; 1:223-8. [PMID: 9259853 DOI: 10.1111/j.1365-3148.1991.tb00037.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A monoclonal IgG anti-human IgG, 1B12, was used in a radio-ligand-binding assay to quantify IgG on erythrocytes of patients and normals. The assay detected a range of 10-700 IgG molecules. Good correlation was achieved between the number of molecules and the strength of agglutination in antiglobulin tests performed in capillary tubes. The assay was capable of detecting subagglutinating immune bound IgG on erythrocytes from patients with systemic lupus erythematosus (SLE).
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Affiliation(s)
- C M Giles
- Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
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21
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Sokol RJ, Hewitt S, Booker DJ, Stamps R, Booth JR. An enzyme-linked direct antiglobulin test for assessing erythrocyte bound immunoglobulins. J Immunol Methods 1988; 106:31-5. [PMID: 3339250 DOI: 10.1016/0022-1759(88)90268-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An enzyme-linked direct antiglobulin test (DAGT) for assessing erythrocyte-bound IgG, IgM and IgA is described. The test is carried out in microtitre plates using heavy chain-specific, alkaline phosphatase-linked, goat anti-human globulin reagents with p-nitrophenyl phosphate as substrate. Results are expressed in optical density (OD) units per 3.6 X 10(7) red cells. The method is reproducible, with coefficients of variation of 0.056, 0.093 and 0.087 for IgG, IgM and IgA respectively. The linear relationship between the amount of red cell-bound antibody and the OD reading for each immunoglobulin class shows that the method is suitable for quantitative studies. Healthy individuals were found to have small amounts of immunoglobulin bound to their red cells with mean values of 0.251, 0.087 and 0.128 OD units per 3.6 X 10(7) red cells for IgG, IgM and IgA respectively; there was no difference between male and female subjects. In the clinical situation, the enzyme-linked DAGT was considered to show significantly increased amounts of cell-bound immunoglobulin when the results were more than three standard deviations above the mean and the quantitative results permitted an accurate assessment of the progress and response to treatment of patients with autoimmune haemolysis.
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Affiliation(s)
- R J Sokol
- Regional Blood Transfusion Centre, Sheffield, U.K
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Sokol RJ, Hewitt S, Booker DJ, Stamps R. Small quantities of erythrocyte bound immunoglobulins and autoimmune haemolysis. J Clin Pathol 1987; 40:254-7. [PMID: 3558858 PMCID: PMC1140894 DOI: 10.1136/jcp.40.3.254] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Enzyme linked and radioimmune direct antiglobulin tests (DAGTs) were used to assess red cell bound IgG, IgA, and IgM in 585 patients referred to an immunohaematology reference centre. One hundred and fifty eight patients with less than or equal to 200 mol IgG and small amounts of IgA and IgM coating their red cells were studied in detail. The presence of autoimmune haemolysis was determined from the clinical, haematological, and biochemical findings; it occurred in at least 25% of the 158 patients, the degree varying widely. There was a highly significant association between small increases in cell bound immunoglobulins and the presence of autoimmune haemolysis. Immunoglobulins of IgG, IgA, and IgM classes could produce autoimmune haemolysis when the classical agglutination DAGTs were negative; the IgA and IgM were usually found in association with IgG. The haemolytic effect was enhanced by the presence of complement and combinations of immunoglobulin classes on the red cells.
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Ben-Izhak C, Shechter Y, Tatarsky I. Significance of multiple types of antibodies on red blood cells of patients with positive direct antiglobulin test: a study of monospecific antiglobulin reactions in 85 patients. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1985; 35:102-8. [PMID: 3876592 DOI: 10.1111/j.1600-0609.1985.tb00808.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Blood samples from 85 patients with a positive direct antiglobulin test were tested with monospecific antiglobulin reagents: anti-IgG, anti-IgM, anti-IgA, and anti-C3. No typical pattern of antiglobulin reaction could be correlated with specific diseases except for the patients with methyldopa-induced positive direct antiglobulin test, all of whom had only IgG on their red blood cells. The presence of more than 1 type of antibody on red blood cells was associated with severe haemolysis. These patients responded less frequently to steroids, and in most of them no underlying disease could be found. Most patients with complement alone on red blood cells had no evidence of haemolysis, and when present it was never severe.
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Jungi TW, Barandun S. Estimation of the degree of opsonization of homologous erythrocytes by IgG for intravenous and intramuscular use. Vox Sang 1985; 49:9-19. [PMID: 4013145 DOI: 10.1111/j.1423-0410.1985.tb00762.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In an effort to evaluate the capacity of polyspecific IgG preparations to sensitize homologous erythrocytes, immunoglobulin G for intramuscular use and an IgG preparation for intravenous use were tested for their tendency to associate with and to opsonize homologous erythrocytes. It was found that the amount of IgG associated with erythrocytes by far exceeded the opsonic moiety. Erythrocytes incubated in IgG in amounts higher than that achieved in vivo after 5 infusions of 0.4 g/kg body weight each, were sometimes lightly opsonized when tested on rosette formation with and phagocytosis by adherent monocytes. IgG for intravenous use was lower than IgG for intramuscular use in its opsonic activity and did often not reach the level of significance. Comparison with rosette formation and phagocytosis of erythrocytes with known amounts of antibodies allowed the prediction that following high-dose infusion of IgG, less than 25 opsonic molecules per red blood cell are achieved in recipients of blood groups A, B, and AB (and probably even less in those of blood group (O). Erythrocytes preincubated in polyspecific IgG failed to inhibit phagocytosis of optimally sensitized erythrocytes by cultured macrophages.
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25
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Salama A, Mueller-Eckhardt C, Bhakdi S. A two-stage immunoradiometric assay with 125I-staphylococcal protein A for the detection of antibodies and complement on human blood cells. Vox Sang 1985; 48:239-45. [PMID: 3984309 DOI: 10.1111/j.1423-0410.1985.tb00178.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A sensitive two-stage immunoradiometric assay (IRMA) using unlabeled specific antiglobulin sera followed by binding of radiolabeled staphylococcal protein A has been developed for detection of human IgG, IgM, IgA and complement C3 on human blood cells. In an experimental model system, purified human immunoglobulins (Ig) were coupled onto red blood cells, platelets, and leukocytes. The Ig-coated red blood cells were analyzed in parallel by three methods: the radioimmune antiglobulin test with radiolabeled anti-Ig; the radiolabeled staphyloccal protein A test, and the IRMA. Of the three methods evaluated, the latter was found to be sensitive and the easiest to perform. The applicability of the IRMA was established by investigating a group of 14 selected patients with autoimmune warm type hemolytic anemia. We observed that the IRMA detected cell-bound antibodies (IgG and/or IgM) in several cases where conventional assays yielded negative results.
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Jeje MO, Blajchman MA, Steeves K, Horsewood P, Kelton JG. Quantitation of red cell-associated IgG using an immunoradiometric assay. Transfusion 1984; 24:473-6. [PMID: 6506176 DOI: 10.1046/j.1537-2995.1984.24685066803.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In this report, we describe a sensitive immunoradiometric assay (IRMA) for quantitating IgG on the surface of red cells. Washed red cells were prepared to a purity of greater than 99.9 percent. Varying dilutions of these cells were incubated with a fixed concentration of 125I-anti-IgG. After equilibrium was achieved, the unbound 125I-anti-IgG was measured by the addition of IgG covalently linked to agarose beads. The red cells were lysed by detergent, and the 125I-anti-IgG bound to the IgG-beads was measured. The amount of IgG on the red cells was determined by relating the concentration of test red cells causing 50 percent inhibition of binding of the 125I-anti-IgG to the IgG-beads to 50 percent inhibition of binding caused by the IgG standard. Using this assay, the red cell-associated IgG (RCA-IgG) of 20 healthy male and female controls with normal hemoglobin concentrations was 7.23 +/- 6.11 fg IgG per 10(3) cells (mean +/- 2 SD). The mean RCA-IgG on washed cells from 34 different tests performed on 19 anemic patients with clinically diagnosed autoimmune hemolytic anemia was 176.1 +/- 375.6 fg IgG per 10(3) cells. There was no correlation between the levels of RCA-IgG and the hemoglobin levels or reticulocyte counts in these patients.
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Merry AH, Thomson EE, Rawlinson VI, Stratton F. Quantitation of IgG on Erythrocytes: correlation of number of IgG molecules per cell with the strength of the direct and indirect antiglobulin tests. Vox Sang 1984; 47:73-81. [PMID: 6741035 DOI: 10.1111/j.1423-0410.1984.tb01564.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The number of IgG molecules bound to the erythrocyte surface for a given agglutination score in the antiglobulin test was studied with several different examples of anti-D, anti-E, anti-c, anti-Kell, anti-Fya, anti-Jka and immune anti-A antisera. The serological scores show a significant correlation with the mean values for bound IgG molecules within a restricted range, although the number bound for a given score may vary by up to 20%. The limit of detection was 100-120 IgG molecules per cell and when over 1,000 were bound, the cells were completely agglutinated. Anti-Kell bound under low ionic strength saline conditions required a greater number of molecules for a given agglutination strength. The relatively low levels of bound IgG necessary to give strong agglutination make the direct antiglobulin test (DAT) less valuable for following the progress of auto-immune haemolytic anaemia (AIHA) than a quantitative test. The latter test does not, however, provide any additional information in AIHA cases with a negative DAT as in these the anaemia does not appear to be due simply to the number of bound IgG molecules. Detection of certain antibodies may not be achieved simply by increasing the sensitivity of the antiglobulin test when correctly performed.
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Spitalnik S, Cowles J, Cox MT, Baker D, Holt J, Blumberg N. A new technique in quantitative immunohematology: solid-phase kinetic enzyme-linked immunosorbent assay. Vox Sang 1983; 45:440-8. [PMID: 6362193 DOI: 10.1111/j.1423-0410.1983.tb01942.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A solid-phase kinetic enzyme-linked immunosorbent assay has been developed to measure binding of antibodies to purified or synthetic blood group antigens and tested in the Lewis blood group system. Chemically synthesized Lewis a antigen is used as the target for the binding of serum antibody in this sandwich-type assay. Kinetic, rather than endpoint, determinations are used to calculate the amount of specific antibody. Data are presented showing the assay to be quantitative, sensitive, and specific. It can separately quantitate the amount of IgG or IgM anti-Lewis a present in patient sera. The assay uses commercially available reagents and is semiautomated. Thus, it will be useful for studies in quantitative immunohematology as other blood group antigens become available in purified form.
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Jones CE, Lee CT, Skinner W, Lamott JA, Koyama HH, Maxwell KW, Fudenberg HH. Radioimmunoassay for immunoglobulin G autoantibody on the surface of mouse erythrocytes. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1983; 29:157-66. [PMID: 6627756 DOI: 10.1016/0090-1229(83)90021-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A radioimmunoassay (RIA) for the determination of autoantibody on the surface of erythrocytes from New Zealand Black (NZB) mice is described. This method was adapted to hemagglutination plates in order to facilitate the separation of bound and unbound 125I-labeled rabbit anti-mouse immunoglobulin G with an automated cell harvester. Intra- and interday precision, over the useful quantitative range of the standard curve, was 3.9 and 12.9%, respectively. The RIA was five to ten times more sensitive than the direct antiglobulin test which, unlike the RIA, provided little quantitative information on a group of 20 experimental NZB mice. This is publication number 562 from the Department of Basic and Clinical Immunology and Microbiology, Medical University of South Carolina.
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Abstract
Unexplained hemolytic anemia in pregnancy is a rare condition. Striking anemia beginning in the first (38%) or second (38%) trimester, resolving within 5 months of delivery (18 of 19 patients, 95%) and recurring in a subsequent pregnancy (six of 12 patients, 50%) was noted in a total of 19 pregnancies in 12 women. Transient hemolysis was present in four of 19 (22%) infants. The etiology of this problem is unknown, and the only factor clearly associated with the anemia is the gravid state. Characteristic of this problem is the absence of any identifiable immune mechanism or intracorpuscular or extracorpuscular defects despite the use of specific and sensitive complement-fixation antibody consumption techniques and assay of all red blood cell enzymes. Important in the management of these patients is the clinical observation that they do respond (seven of seven patients) to corticosteroid therapy and can experience a normal delivery. Although not frequent, this problem can be life threatening to both mother and child. With early recognition and appropriate treatment with corticosteroids the hazards of this condition can be avoided.
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Abstract
Autoreactive antibodies or immune complexes may accelerate clearance of mature erythrocytes, leukocytes, and platelets from the circulation in patients with rheumatologic and immunologic disorders. The most compelling evidence for immune injury to hematopoietic cells exists in patients with systemic lupus erythematosus and patients with Felty's syndrome and its variants. These disorders may also cause tissue inflammation, which in turn commonly results in underproduction of erythrocytes and development of thrombocytosis. However, recent evidence indicates that underproduction of hematopoietic cells may also result from immune injury to cellular elements in the bone marrow. In many laboratories, sensitive techniques are now clinically available for the detection of cell-associated immunoglobulin and complement. These assays have helped confirm the role of antibody in the pathogenesis of autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura. However, recent data indicate that there is probably a continuum between the amount of immunoglobulin and complement found on normal cells and that found in a variety of disease states. In several of these disorders, additional evidence will be required to establish that the increase in cell-bound immunoglobulin leads to a decrease in the life-span of the cell. In order to provide significant help to the clinician managing an individual patient, these serologic tests must be capable of identifying the portion of the cell-associated protein actually involved in the destructive process. The availability of monoclonal reagents capable of identifying restricted regions on cell-bound immunoglobulin may help identify molecules bound specifically as antibody and may help identify the antigens involved in autoimmune disorders.
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Inada Y, Kamiyama M, Kanemitsu T, Hyman CL, Clark WS. Studies on immune adherence (C3b) receptor activity of human erythrocytes: relationship between receptor activity and presence of immune complexes in serum. Clin Exp Immunol 1982; 50:189-97. [PMID: 6216998 PMCID: PMC1536856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Human erythrocytes (E) have surface receptors for the third component of complement (C3b-IA receptors) which mediate immune adherence haemagglutination (IAHA). We have observed that E from patients with systemic lupus erythematosus had imparied or defective C3b receptor (C3b-R) activity when circulating immune complexes (CIC) were found in serum. This phenomenon has been investigated by a newly developed method involving competitive inhibition of IAHA in patients with immune complex diseases. IAHA involving sheep E coated with antibody and complement (EAC), and indicator human E was inhibited by lysates of E with normal C3b-R activity from healthy donors and a monkey. In contrast, the lysates of E from 95% of patients bearing CIC did not inhibit IAHA, which indicated such E had defective or impaired C3b-R activity. This phenomenon was supported by control studies in which IAHA was not inhibited by lysates of E with absent, inactivated or occupied C3b-R. In those patients, in whom CIC disappeared during immunosuppressive therapy, C3b-R activity slowly returned to normal levels. Moreover, it was observed that C3b-R activity of patients' E decreased with the reappearance of CIC during exacerbations of disease. These observations suggest that CIC are carried in vivo by the C3b-R of E as well as those of the mononuclear phagocyte system, and that the E C3b-R may also contribute to the clearance of CIC.
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Abstract
A severe illness developed gradually in a healthy boy following administration of live measles vaccine at age 14 years. Killed measles vaccine had been given at age 2. Panniculitis began near the site of live vaccine injection, extended contiguously to involve the entire upper arm, and then began to appear in distant subcutaneous sites. He was febrile, leukopenic, anemic, and lost weight rapidly. Evidence of a cause-and-effect relationship between the lesions and the measles vaccine included biopsy findings of particles closely resembling measles nucleocapsids and complete virions by electron microscopy, positive fluorescence after staining with two anti-measles nucleocapsid sera, and immunologic aberrations. The lesions regressed after various treatments and completely remitted on two occasions, but recurred. He became severely malnourished and finally died 29 months after the measles vaccination. At autopsy, pannicultitis was found in the subcutis and mesentery, without evidence of involvement of the brain or other vital organs.
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Schmitz N, Djibey I, Kretschmer V, Mahn I, Mueller-Eckhardt C. Assessment of red cell autoantibodies in autoimmune hemolytic anemia of warm type by a radioactive anti-IgG test. Vox Sang 1981; 41:224-30. [PMID: 7336676 DOI: 10.1111/j.1423-0410.1981.tb01040.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To evaluate the applicability of a radioactive 125I-anti-IgG test (RIAT) for the detection of small amounts of IgG antibodies on red blood cells (RBC) of patients with autoimmune hemolytic anemia of warm type (AIHA), RBC of 125 patients were studied (AIHA, n = 53; Coombs'-negative AIHA, n = 6; chronic cold agglutinin disease, n = 7; non-immune anemias, n = 59). It was found that the RBC of all cases (33/33) with a positive direct IgG antiglobulin test (DAT-IgG), but also 13 out of 20 patients with a negative DAT-IgG, but detectable complement (C3/C4), and 4 out of 6 cases with Coombs'-negative AIHA gave positive results in the direct RIAT. RBC-associated IgG was higher in the DAT-IgG positive group (n = 33; -x = 8.1%) than in the DAT-IgG negative group (n = 26; -x3.4%). There was no correlation between hypergammaglobulinemia and RBC-associated IgG. The sensitivity of the indirect RIAT was not remarkable better as compared to the indirect antiglobulin test. The RIAT is valuable in the serology of borderline cases of AIHA.
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35
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Hegde UM, Powell DK, Bowes A, Gordon-Smith EC. Enzyme linked immunoassay for the detection of platelet associated IgG. Br J Haematol 1981; 48:39-46. [PMID: 7248190 DOI: 10.1111/j.1365-2141.1981.00039.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An enzyme linked immunoassay incorporating antihuman globulin coupled with alkaline phosphatase has been developed to measure platelet associated IgG (PAIgG). Using a method in which platelet IgG is extracted into the fluid phase after appropriate procedures, we were able to bind the 'solubilized' PAIgG to commercially obtained antihuman IgG (AHG) which had previously been coated onto polystyrene. The amount of PAIgG thus bound was subsequently measured by the addition of the enzyme reagent using p-nitro phenyl phosphate as substrate. With this technique platelets from normal donors were found to have 2.6-17.4 ng/10(6) platelets (mean +/-2 SD). These values are higher than those obtained when assay systems using intact platelets are employed. Platelets from patients with immune thrombocytopenia had PAIgG values of 8.2-98.0 ng/10(6) platelets. In a few patients with disorders other than autoimmune thrombocytopenia (AITP) increased levels of PAIgG were also demonstrated. The assumption that increased PAIgG always represents platelet autoantibody may not be valid. The relevance of PAIgG as a parameter in the diagnosis and clinical management of patients with AITP is discussed.
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36
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Galili U, Manny N, Izak G. EA rosette formation: a simple means to increase sensitivity of the antiglobulin test in patients with anti red cell antibodies. Br J Haematol 1981; 47:227-33. [PMID: 6937216 DOI: 10.1111/j.1365-2141.1981.tb02783.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Erythrocyte antibody (EA) rosette formation with the Fc-receptor on the K-562 erythro-myeloid cell line was employed for the detection of subagglutinating amounts of Ig molecules bound to red cells. The sensitivity of this method exceeds that of the conventional direct and indirect antiglobulin tests without any alteration of the incubation media or pretreatment of red cells. The increased sensitivity did not diminish the specificity of the test, which can detect IgG, IgM and complement as well. This method may demonstrate the presence of antibodies on red cells in patients with suspected autoimmune haemolytic anaemia and negative antiglobulin test.
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37
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van der Meulen FW, de Bruin HG, Goosen PC, Bruynes EC, Joustra-Maas CJ, Telkamp HG, von dem Borne AE, Engelfriet CP. Quantitative aspects of the destruction of red cells sensitized with IgG1 autoantibodies: an application of flow cytofluorometry. Br J Haematol 1980; 46:47-56. [PMID: 7000155 DOI: 10.1111/j.1365-2141.1980.tb05934.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The purpose of this study was to determine whether quantitative or qualitative factors are of major importance in the destruction of red cells sensitized with incomplete warm autoantibodies of subclass IgG1. To that end, the relative amount of igG1 antibody present on the red cells of patients with autoantibodies of this subclass only, was measured by means of continuous flow cytofluorometry. This method appeared to give an idea of the amount of antibody on red cells and was reproducible. The intensity of the fluorescence of patient's red cells, measured after incubation with a FITC-labelled anti-IgG1, was compared with the presence or absence of signs of increased haemolysis in vivo and the cytotoxic activity of normal monocytes towards these red cells in vitro. It appearedthat it was predominantly the amount of IgG1 autoantibody that determined whether or not these antibodies induced haemolysis in vivo or cytotoxicity of monocytes in vitro. This was also true with methyldopa-induced IgG1 autoantibodies.
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Abstract
Immune hemolytic anemia is an acquired anemia resulting from the premature destruction of red cells caused by the presence of antibody and/or complement on the red cell surface. The Coombs test, modified and improved, remains the mainstay of diagnosis.
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39
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Lambermont M, Wybran J. Erythrocyte autoimmune disorder: red cell antibodies and the human allogeneic rosette test. Clin Exp Immunol 1980; 39:635-44. [PMID: 6966550 PMCID: PMC1538132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A new test termed the human allogeneic rosette test (HART) is reported for the detection of small amounts of erythrocyte autoantibodies. It compares the percentage of rosettes formed around lymphocytes from normal subjects when either red cells from patients are added or autologous or allogeneic normal red cells. The HART is positive when the percentage of rosettes made with the control's red blood cells is significantly more than the percentage of those made with the patient's red blood cells. Twenty-two out of twenty-six patients with a positive antiglobulin test had a positive HART. Thirty patients with a negative antiglobulin test but with clinical or biological data suggesting an erythrocyte autoimmune disorder were also studied with the HART. Out of sixteen patients with chronic lymphatic leukaemia, ten had a positive test; all three patients with idiopathic thrombocytopenic purpura showed a positive HART; two out of three patients with cirrhosis and one out of four patients with Hodgkin's disease also had a positive test. No correlation was found between the positivity of the HART in these patients and their haematological values. Two patients with suspected autoimmune haemolytic anaemia and with a negative anti-globulin test but a positive HART were treated with steroids. Both responded very rapidly to the treatment suggesting an immune origin for the anaemia. The HART has been reproduced experimentally. Normal human red blood cells, sensitized with different amounts of either an auto-antibody or anti-D were rosetted with autologous normal lymphocytes. The results showed that the percentage of rosettes with red cells coated with small amounts of antibody was significantly less than the percentage of rosettes with uncoated red cells. A plot of these results seemed to indicate that the HART was about twenty times more sensitive than the antiglobulin test. The nature of the cells involved in the positive HART-negative direct antiglobulin test red cell binding was also analysed. They appear to be related to the T cell population. The role of the receptors for IgG in the HART was demonstrated by showing that aggregated and non-aggregated human IgG could inhibit the HART phenomenon. In conclusion, the HART appears to be a new and sensitive immunological test capable of analysing erythrocyte autoimmune disorders.
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Yam P, Wilkinson L, Petz LD, Garratty G. Studies on hemolytic anemia in pregnancy with evidence for autoimmunization in a patient with a negative direct antiglobulin (Coombs') test. Am J Hematol 1980; 8:23-9. [PMID: 7395861 DOI: 10.1002/ajh.2830080104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Toma VA, Iturralde M, Anderson JD, Retief FP. Is the d an allelic gene of D in the Rh blood group system? A quantitative study using 99mTechnetium-pyrophosphate-labelled antibody (TcLA) method. J Immunol Methods 1979; 27:273-82. [PMID: 112193 DOI: 10.1016/0022-1759(79)90224-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reports on studies of Rh antigens, such as D, Du and d, using uranyl-labelled antibody (ULA) and TcLA (99mTc-pyrophosphate-labelled antibody) methods for the first time for this purpose. TcLA method proved to be simple in labelling and very sensitive (20--100 times more so than the indirect Coombs test) in the detection of Rh antigen-antibody binding. Results of this quantitative study demonstrate convincingly that the d is not an allelic gene of D but rather the weakest of the series D less than Du less than d. Although the evidence from this study demonstrates clearly that differences between D and d are only quantitative, the authors do not think that the Rh nomenclature should be changed but they do think that the present evidence should be used in regard to the understanding of the allelism in the Rh blood group system. The c is an allelic gene of C as the e is an allelic gene of E; specific test sera detecting every one of these antigens exist and the family studies verify these statements. However, the d is not a distinct antigen as c and e are, even if the pattern of inheritance from family studies, using the existent anti-D serum, would suggest the allelism as probability. That is why in the past the anti-Du and anti-d specific test sera never incidentally found or artificially produced.
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43
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Martinelli GP, Osler AG. The application of complement fixation to antibody weight estimates I. To soluble antigens. J Immunol Methods 1978; 22:175-90. [PMID: 670725 DOI: 10.1016/0022-1759(78)90070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A method is described for estimating early mouse IgG antibodies to the dinitrophenyl (DNP) determinant in absolute weight units. The antibodies to be measured are adsorbed quantitatively onto an appropriate immunoadsorbent such as DNP polyacrylamide. The particulate immune complexes are then incubated with a standard dilution of a potent rabbit antiserum to mouse IgG. Removal of the rabbit anti-mouse IgG (RaM) immunoglobulins by the complexes decreases the C fixing ability of the RaM supernatants reacted with C and mouse IgG. The decrements in C fixation are linearly related to the logarithm of the weight of mouse IgG. The decrements in C fixation are linearly related to the logarithm of the weight of mouse IgG anti DNP added to the immunoadsorbent. A calibration curve is constructed with known amounts of mouse IgG )anti-NDP as measured by quantitative precipitation. Concurrent assays with the early mouse anti-DNP sera permit conversion of the losses in C fixing potencies to weight units of mouse IgG anti-DNP by interpolation on the calibration curve.
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45
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Curd JG, Sundsmo JS, Kolb WP, Bluestein HG, Müller-Eberhard HJ. Neoantigen of the membrane attack complex of human complement: Occurrence on peripheral blood leukocytes from patients with systemic lupus erythematosus. ARTHRITIS AND RHEUMATISM 1978; 21:177-82. [PMID: 76471 DOI: 10.1002/art.1780210201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since complement activation and hematological abnormalities occur in systemic lupus erythematosus (SLE), the present study is an investigation of whether the membrane attack complex of complement might be bound to peripheral blood leukocytes (PBL) in vivo. Assembly of the membrane attack complex results in the generation of neoantigen (neoAg) which is complex-specific and not expressed by any of the individual complement proteins. FITC antiserum specific to neoAg was employed to detect the membrane attack complex on PBL from 7 normal donors, 12 patients with SLE, and 2 patients with rheumatoid arthritis (RA): 3 +/- 1% of normal, 25 +/- 13% of SLE, and 23 +/- 11% of RA PBL were positive. The majority of the neoAg positive PBL in SLE were polymorphonuclear neutrophils (PMN) as shown by adherence to plastic, phagocytosis of carbonyl iron, and differential cell counts. The PBL were greater than 98% viable as indicated by the trypan blue exclusion technique. These observations strongly suggest that the membrane attack complex may be bound to viable PBL in patients with SLE and RA, and further raise the possibility that the membrane attack complex, may have a function other than lysis.
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46
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Cohen JR. Pathogenesis of hemolysis in immune hemolytic anemia. West J Med 1977; 127:363-5. [PMID: 919537 PMCID: PMC1237855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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47
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Schreiber AD, Herskovitz BS, Goldwein M. Low-titer cold-hemagglutinin disease. Mechanism of hemolysis and response to corticosteroids. N Engl J Med 1977; 296:1490-4. [PMID: 865527 DOI: 10.1056/nejm197706302962602] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We studied two patients with a low-titer cold-hemagglutinin disease syndrome to investigate the mechanism of hemolysis and the therapeutic response to corticosteroids. The antierythrocyte antibody was of the IgM class, had a high thermal amplitude and had enough activity of 37 degrees C to account for the hemolysis. The capacity of peripheral blood monocytes to increase the osmotic fragility of C3-coated erythrocytes suggests that macrophage interaction with C3-coated erythrocytes explains the observed in vivo spherocytosis. Both patients responded to high-dose corticosteroids. The data suggest that the steroid effect is probably due to alteration of macrophage complement-receptor function. These studies demonstrate the importance of antibody activity at body temperature in producing hemolysis, particularly in this variant of cold-hemagglutinin disease. The response to steroids suggests the efficacy of corticosteroid therapy in alleviating hemolysis due to macrophage recognition of erythrocytes coated with IgM and C3.
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48
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Abstract
The records of 22 children with the diagnosis of idiopathic immune hemolytic anemia were reviewed. Fifty per cent of the children had a history of an antecedent infection and 32% had underlying immune deficiency or lymphoproliferative diseases. The majority (77%) of the patients had an acute self-limited disease which was frequently associated with a positive complement or nongamma Coombs test. The anemia was usually severe, and a number of the children had reticulocytopenia at the time of diagnosis. These children responded rapidly to transfusions and corticosteroids and generally remained well on follow-up. Immunosuppressive drugs did not prove useful in two patients refractory to prednisone, but splenectomy was apparently beneficial in three of four patients so treated. Mortality rate was 18%, with most of the deaths related to an underlying disease.
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49
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Greenwalt TJ, Swierk EM, Steane EA. Use of horseradish peroxidase-labelled antiglobulin for the colorimetric quantitation of erythrocyte antibodies. J Immunol Methods 1975; 8:351-61. [PMID: 811709 DOI: 10.1016/0022-1759(75)90057-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Horseradish peroxidase (HRP)-labelled antiglobulin has been used extensively as a histochemical marker. In the method described the stable reaction product formed by using 3,3'-diaminobenzidine (DAB) as the hydrogen donor in the peroxidase reaction was dissolved in a fluoro alcohol, 1,1,1,3,3,3-hexafluoroisopropanol (HPF). Reproducible standardisation curves resulted with HRP. Based on these observations a colorimetric assay procedure was developed to quantitate the amount of antibody coating red cells. This was achieved by treating the coated red blood cells with HRP-labelled rabbit antihuman IgG followed by hypotonic lysis separating the ghosts for colour development with the DAB reagent, solubilisation in HFP, and reading at 450 nm. Preliminary estimates of the number of anti-D molecules on Rhesus positive red cells were found to approximate the results reported using radioiodinated antibodies. The smallest number of anti-D molecules detected was 350 per red cell. Qualitative studies indicate that this procedure can be applied to other blood group systems.
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50
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Pope RM, Teller DC, Mannik M. Intermediate complexes formed by self-association of IgG-rheumatoid factors. Ann N Y Acad Sci 1975; 256:82-7. [PMID: 51605 DOI: 10.1111/j.1749-6632.1975.tb36037.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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