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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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Kamesaki T. Diagnostic algorithm for classification and characterization of direct antiglobulin test-negative autoimmune hemolytic anemia with 1-year clinical follow-up. Transfusion 2021; 62:205-216. [PMID: 34668206 DOI: 10.1111/trf.16709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 5%-10% of autoimmune hemolytic anemia (AIHA) cases are negative for direct antiglobulin test (DAT). We previously reported a classification system for untreated patients with DAT-negative AIHA by quantifying levels of red blood cell (RBC)-bound IgG. This study investigated the clinical utility of a novel diagnostic algorithm with a comprehensive classification system and characterized each subgroup in DAT-negative AIHA. STUDY DESIGN AND METHODS We assessed 637 patients with undiagnosed hemolytic anemia using our diagnostic algorithm and classification system, which was based on RBC-bound IgG levels and results of column method-DAT before and after washing RBCs. RESULTS Patients were diagnosed with DAT-negative AIHA with 97% sensitivity and 84% specificity when the laboratory tests were performed before treatment and classified into the following six categories: tube DAT-negative, low-affinity IgG, double DAT-negative, IgA- or IgM-positive, low-affinity IgM, and s/o non-AIHA. The first three types were major conditions and accounted for 76% of DAT-negative AIHA cases. Based on multivariate analyses of idiopathic DAT-negative AIHA (n = 71), platelet count and albumin concentration were significant factors for survival at 1-year follow-up. The low-affinity IgG group showed the highest platelet count and albumin levels, better response to steroids, and higher 1-year survival rate than those in other groups. DISCUSSION Our classification included DAT-negative, IgA-driven, and warm-IgM AIHA categories, which were atypical forms of AIHA with the severe onset and increased risk of relapse. When treating a patient with DAT-negative hemolysis, atypical AIHA should be considered and tested in reference laboratories, especially before treatment.
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Affiliation(s)
- Toyomi Kamesaki
- Division of Support in Community Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
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Kitao A, Kawamoto S, Kurata K, Hayakawa I, Yamasaki T, Matsuoka H, Sumi Y, Kakeji Y, Kamesaki T, Minami H. Band 3 ectopic expression in colorectal cancer induces an increase in erythrocyte membrane-bound IgG and may cause immune-related anemia. Int J Hematol 2020; 111:657-666. [PMID: 31997080 DOI: 10.1007/s12185-020-02831-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 12/20/2022]
Abstract
Autoimmune hemolytic anemia (AIHA) is a rare comorbidity in colorectal cancer (CRC) and has an unknown etiology. Previously, we described an AIHA case secondary to CRC with ectopic band 3 expression. Herein, we investigated ectopic band 3 expression and erythrocyte membrane-bound IgG in a CRC cohort. Between September 2016 and August 2018, 50 patients with CRC and 26 healthy controls were enrolled in the present study. The expression of band 3 and SLC4A1 mRNA was observed in 97% of CRC surgical specimens. Although clinical AIHA was not observed in any patient with CRC, a direct antiglobulin test was positive in 10 of the patients in the CRC group (p = 0.01). Flow cytometry revealed significantly increased erythrocyte membrane-bound IgG among patients with CRC compared to healthy controls (mean ± standard deviation; 38.8 ± 4.7 vs. 29.9 ± 15.6, p = 0.012). Normocytic anemia was observed, including in cases negative for fecal occult blood, suggesting a shortened erythrocyte life-span due to increased membrane-bound IgG. Immunoprecipitation revealed increased anti-band 3 autoantibodies in patients' sera. Mouse experiments recapitulated this phenomenon. We also confirmed that band 3 expression is controlled by 5'AMP-activated protein kinase under hypoxic conditions. These findings increase our understanding of the etiology of cancer-related anemia.
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Affiliation(s)
- Akihito Kitao
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Shinichiro Kawamoto
- Department of Transfusion Medicine and Cell Therapy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Keiji Kurata
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Ikuyo Hayakawa
- Department of Transfusion Medicine and Cell Therapy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takashi Yamasaki
- Department of Diagnostic Pathology, Kohnan Hospital, Kobe, Hyogo, Japan
| | - Hiroshi Matsuoka
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Yasuo Sumi
- Department of Surgery, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Toyomi Kamesaki
- Center for Community Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
- Department of Transfusion Medicine and Cell Therapy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Khunger JM, Pati HP, Mahapatra M, Khunger A. Utilisation of Flow-cytometry in the Diagnosis of Auto Immune Haemolytic Anaemia. Indian J Hematol Blood Transfus 2019; 35:297-303. [PMID: 30988567 PMCID: PMC6439060 DOI: 10.1007/s12288-018-1017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022] Open
Abstract
Auto Immune Haemolytic Anaemia (AIHA) is one of the most common types of acquired haemolytic anaemias. Its main cause is auto-antibody mediated rapid destruction of Red Blood Cells (RBCs). Demonstration of a positive Direct Antiglobulin Test also known as Coomb's test, against these autoantibodies is the crucial serological assay in the diagnosis of AIHA. This routinely used test has the disadvantage of low sensitivity and does not detect low levels of red cell auto antibodies leading to false negative results sometimes. Flow cytometry can effectively diagnose such patients with low levels of autoantibodies. This study was carried out in a tertiary care center, where patients with suspected AIHA were studied during 2 years period. Blood samples of suspected patients of AIHA were tested by both Gel Card Test and by Flow-cytometry for detection of RBC bound IgG. A total of 50 patients with suspected diagnosis of AIHA were studied by flow-cytometry as well as by Gel card test for detection of RBC bound IgG. Out of these 50 cases, 41 cases have turned out to be positive and 9 were negative by flow-cytometry. By Gel card test, out of 50 cases, 34 were positive and 16 were negative. Therefore, there were 7 cases which were negative for RBC bound IgG by Gel card test and these were positive by flow-cytometry. Flow-cytometry is a reliable and more sensitive method and can be used as a new routine diagnostic technique for AIHA.
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Affiliation(s)
- Jitender Mohan Khunger
- Haematology Department, Vardhman Mahavir Medical College & Safdar Jang Hospital, New Delhi, 110029 India
| | - H. P. Pati
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M. Mahapatra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Kelton JG, Vrbensky JR, Arnold DM. How do we diagnose immune thrombocytopenia in 2018? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:561-567. [PMID: 30504358 PMCID: PMC6245958 DOI: 10.1182/asheducation-2018.1.561] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
In this report, we will review the various clinical and laboratory approaches to diagnosing immune thrombocytopenia (ITP), with a focus on its laboratory diagnosis. We will also summarize the results from a number of laboratories that have applied techniques to detect anti-platelet autoantibodies as diagnostic tests for ITP. Although there is considerable variability in methods among laboratories, there is general agreement that platelet autoantibody testing has a high specificity but low sensitivity. This suggests several possibilities: (1) the ideal test for ITP has yet to be developed, (2) current test methods need to be improved, or (3) ITP is the clinical expression of a variety of thrombocytopenic disorders with different underlying mechanisms. Even the clinical diagnosis of ITP is complex, and experienced clinicians do not always agree on whether a particular patient has ITP. Improvements in the diagnostic approach to ITP are necessary to improve the management of this disorder.
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Affiliation(s)
- John G. Kelton
- Michael G. DeGroote School of Medicine, Department of Medicine and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Initiative for Innovation in Healthcare, McMaster University, Hamilton, ON, Canada
| | - John R. Vrbensky
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Donald M. Arnold
- Michael G. DeGroote School of Medicine, Department of Medicine and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
- McMaster Centre for Transfusion Research, Hamilton, ON, Canada; and
- Canadian Blood Services, Hamilton, ON, Canada
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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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Bloch EM, Sakac D, Branch HA, Cserti-Gazdewich C, Pendergrast J, Pavenski K, Branch DR. Western immunoblotting as a new tool for investigating direct antiglobulin test-negative autoimmune hemolytic anemias. Transfusion 2015; 55:1529-37. [DOI: 10.1111/trf.13082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/08/2015] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Evgenia M. Bloch
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Centre for Innovation; Canadian Blood Services
| | | | | | - Christine Cserti-Gazdewich
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Centre for Innovation; Canadian Blood Services
- Department of Medicine; University of Toronto
- Toronto General Hospital, University Health Network
| | - Jacob Pendergrast
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Department of Medicine; University of Toronto
- Toronto General Hospital, University Health Network
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- St. Michael's Hospital; Toronto Ontario Canada
| | - Donald R. Branch
- Department of Laboratory Medicine and Pathobiology; University of Toronto
- Centre for Innovation; Canadian Blood Services
- Department of Medicine; University of Toronto
- Toronto General Hospital, University Health Network
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8
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Kamesaki T, Toyotsuji T, Kajii E. Characterization of direct antiglobulin test-negative autoimmune hemolytic anemia: a study of 154 cases. Am J Hematol 2013; 88:93-6. [PMID: 23169533 DOI: 10.1002/ajh.23356] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/11/2012] [Accepted: 10/17/2012] [Indexed: 11/09/2022]
Abstract
Direct antiglobulin test (DAT)-negative (DAT-)autoimmune hemolytic anemia (AIHA) is empirically thought to show the same clinical conditions as DAT-positive (DAT+)AIHA, with the exception of an adequate amount of red blood cell (RBC)-bound immunoglobulin (Ig)G. We investigated the clinical characteristics of DAT-AIHA in comparison with DAT+AIHA. Of the 582 patients referred to our laboratory with undiagnosed hemolytic anemia, AIHA was clinically diagnosed in 216 patients (DAT-AIHA, n = 154; DAT+AIHA, n = 62). The percentage of reticulocytes, mean corpuscular volume, RBC-IgG levels, white blood cell count, and total protein (TP) levels were significantly higher in patients with DAT+AIHA than patients with DAT-AIHA. The hemoglobin level was significantly lower in patients with DAT+AIHA. No significant differences between patients with DAT-AIHA and DAT+AIHA existed with respect to age, gender, idiopathic/secondary nature, complications such as Evans syndrome, effectiveness of steroid treatment, or survival rate at 1 year following diagnosis. Patients with DAT-AIHA required significantly lower doses of steroids for maintenance therapy. Based on multivariate analysis of idiopathic DAT-AIHA (n = 110), TP and Evans syndrome were associated with the effectiveness of steroids (adjusted odds ratio [aOR], 1.36/[0.1 g/dl]; 95% confidence interval [CI], 1.01-1.84) and survival at the 1-year follow-up (aOR, 0.1; 95% CI, 0.01-0.88). Our results indicate that patients with DAT-AIHA generally suffer milder anemia and hemolysis than patients with DAT+AIHA, respond equally well to steroids, and have comparable survival at 1-year.
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Affiliation(s)
- Toyomi Kamesaki
- Center for Community Medicine; Jichi Medical University; Tochigi; Japan
| | | | - Eiji Kajii
- Center for Community Medicine; Jichi Medical University; Tochigi; Japan
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9
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Hannon JL. Management of blood donors and blood donations from individuals found to have a positive direct antiglobulin test. Transfus Med Rev 2011; 26:142-52. [PMID: 22000666 DOI: 10.1016/j.tmrv.2011.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The medical literature is replete with articles addressing the diagnosis and management of patients with a positive direct antiglobulin test (DAT). However, there is scant information addressing the management of blood donors and blood donations found to have a positive DAT. Practices vary considerably between countries and blood suppliers within countries, and there is no standardized approach to the management of these blood donors or the blood products prepared from their donations. Recent evidence from Israel suggests that the finding of a positive DAT in a blood donor may not be as benign as previously thought. Therefore, it may be prudent for blood collection agencies to periodically reexamine their approach to the management of blood donors with a positive DAT and their donations. This article reviews the available literature and explores options for the management of DAT-positive blood donors and their blood donations.
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10
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Shichishima T, Ikeda K, Takahashi N, Kameoka J, Tajima K, Murai K, Tamai Y, Shichishima-Nakamura A, Akutsu K, Noji H, Okamoto M, Kimura H, Harigae H, Oyamada T, Kamesaki T, Takeishi Y, Sawada K. Low concentration of serum haptoglobin has impact on understanding complex pathophysiology in patients with acquired bone marrow failure syndromes. Int J Hematol 2010; 91:602-10. [PMID: 20376581 DOI: 10.1007/s12185-010-0559-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 03/04/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
Abstract
To clarify whether measurement of serum haptoglobin (Hp) has impact on understanding pathophysiology in bone marrow failure (BMF) syndromes, we investigated concentrations of serum Hp by nephelometric procedure in 156 Japanese patients with BMF, including 54 aplastic anemia (AA), 50 paroxysmal nocturnal hemoglobinuria (PNH), and 52 myelodysplastic syndromes (MDS) patients. The frequencies with low concentrations of serum Hp (<42 mg/dL) in PNH patients (98.0%) were significantly higher than those in AA (27.8%; P < 0.0001) and MDS (38.5%; P < 0.0001) patients. In AA patients, white blood cell (WBC), absolute neutrophil, and platelet counts were significantly decreased in the group (n = 15) with low concentrations of serum Hp than in that (n = 39) with normal concentrations of it, and WBC counts were positively correlated with concentrations of serum Hp, suggesting that WBC counts may affect the concentrations. In MDS patients, hemoglobin concentrations and serum iron were significantly decreased and increased, respectively, in the group (n = 20) with low concentrations of serum Hp than in that (n = 32) with normal concentrations of it, and the values of serum iron were inversely correlated with concentrations of serum Hp, suggesting that ineffective erythropoiesis may affect the concentrations. Several AA and MDS patients with low concentrations of serum Hp had Coombs-negative autoimmune hemolytic anemia determined by immunoradiometric assay. In conclusion, several factors in conjunction with pathophysiology contribute to decrease of serum Hp in BMF.
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Affiliation(s)
- Tsutomu Shichishima
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
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Nakao T, Fukushima T, Shimizu T, Nanmoku T, Fujiyama S, Nakajima R, Fukushima F, Noguchi M, Sumazaki R. Transient myelofibrosis with autoimmune pancytopenia: a case report. Eur J Pediatr 2009; 168:1003-6. [PMID: 18987883 DOI: 10.1007/s00431-008-0867-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 10/21/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Myelofibrosis associated with myelodysplasia is thought to herald poor prognosis in myelodysplastic syndrome (MDS). CASE REPORT A 7-month-old boy presented with fever (39 degrees C), pancytopenia, and slight hepatosplenomegaly (3 and 2 cm, respectively). Bone marrow showed hypercellularity, hyperplasia of erythroblasts, and also myelofibrosis. IgG was 1,136 mg/dL, IgA was 131 mg/dL, and IgM was 89 mg/dL. Antinuclear and antineutrophil antibodies, red-blood-cell-associated IgG, antiplatelet antibodies, and Coombs test were positive. Karyotype was 46XY. No viral cause was evidenced. Mild myelodysplasia was revealed two months later, but was insufficient to support a diagnosis of MDS. The boy was treated with transfusion of packed cells, prednisolone 2 mg/kg/day for 3 weeks associated with intravenous gammaglobulin 400 mg/kg/day for 5 days. Direct Coombs remained positive 1 month after treatment for 5 months, myelofibrosis persisted for 3 months, and neutropenia for 21 months. After 3-year follow-up, hematological data were normal without any therapeutic intervention. CONCLUSION Myelofibrosis associated with mild myelodysplasia and pancytopenia can have a benign evolution in infants and young children.
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Affiliation(s)
- Tomohei Nakao
- Department of Pediatric Health, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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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
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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15
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Kondo H, Oyamada T, Mori A, Sumi H, Kurosu K, Kajii E, Mikata A. Direct-antiglobulin-test-negative immune haemolytic anaemia and thrombocytopenia in a patient with Hodgkin's disease. Acta Haematol 2001; 105:233-6. [PMID: 11528097 DOI: 10.1159/000046570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case of direct-antiglobulin-test (DAT)-negative auto-immune haemolytic anaemia (AIHA) and immune thrombocytopenia (ITP) associated with Hodgkin's disease (HD) is reported. A 52-year-old male was admitted with anaemia, thrombocytopenia, and lymphadenopathy. The patient was DAT negative, although he exhibited the clinical features of warm-type AIHA and elevated levels of red-blood-cell-associated IgG (RBC-IgG). The serum level of platelet-associated IgG (PA-IgG) was markedly increased. A biopsy specimen of the inguinal lymph nodes showed HD of mixed cellularity. Marked improvement of subjective symptoms, normalization of haematological values and a decrease in the level of both RBC- and PA-IgG were observed after the start of combination chemotherapy for HD. Although the association of HD, ITP, and/or AIHA has been infrequently reported, the measurement of RBC-IgG is recommended in cases of HD with anaemia even though DAT is negative, since HD is known to be associated with various protean immunological abnormalities.
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Affiliation(s)
- H Kondo
- Division of Haematology and Oncology, Department of Medicine, Shimizu Kohsei Hospital, 578-1 Ihara-cho, Shimuzu-city, Shizuoka 424-0114, Japan.
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16
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Iwamoto S, Kamesaki T, Oyamada T, Okuda H, Kumada M, Omi T, Takahashi J, Tani Y, Omine M, Kajii E. Reactivity of autoantibodies of autoimmune hemolytic anemia with recombinant rhesus blood group antigens or anion transporter band3. Am J Hematol 2001; 68:106-14. [PMID: 11559950 DOI: 10.1002/ajh.1161] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The specificity of autoantibodies in autoimmune hemolytic anemia (AIHA) has been studied using the serological procedure and immunoprecipitation technique with rare phenotype red cells. We attempted to analyze specificity using recombinant rhesus (Rh) blood group and band3 antigens expressed on erythroleukemic cell lines, KU812E. The autoantibody eluates were isolated by the acid elution procedure from the red cells of 20 AIHA patients. The recombinant Rh antigens, RhD, cE, ce, CE, and chimera antigens CE-D and D-CE, were obtained by retroviral cDNA transduction into KU812E cells, and the cell line expressing the antigens was cloned. Band3 cDNA was also obtained and introduced into KU812E and cloned KU812 expressing RhcE. The reactivities of AIHA eluates with recombinant Rh and band3 antigens were studied by flow cytometry. Fifteen eluates reacted with at least one of the RhcE, ce, or CE antigens, and four eluates reacted with RhD. Seven eluates with strong Rh specificity were studied further using chimera antigen. Five eluates showed reduced or lost reactivity, although two eluates reacted identically with the chimera antigens as wild type. These results indicated that conformational epitopes constituted by RhD or CE specific exofacial peptide loops are important for autoantibodies in most cases. Seven eluates reacted with band3, five exclusively. The coexpression study of RhcE and band3 did not enhance the expression of either antigen nor the reactivity with patient eluates, indicating that association of Rh and band3 was not involved in the appearance of autoantigen.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/blood
- Anemia, Hemolytic, Autoimmune/immunology
- Anion Exchange Protein 1, Erythrocyte/immunology
- Anion Exchange Protein 1, Erythrocyte/metabolism
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/metabolism
- Antibody Specificity
- Antigen-Antibody Complex/analysis
- Autoantibodies/blood
- Autoantibodies/immunology
- Autoantibodies/isolation & purification
- Epitopes
- Erythrocytes/chemistry
- Erythrocytes/immunology
- Flow Cytometry
- Humans
- Recombinant Fusion Proteins/immunology
- Recombinant Fusion Proteins/metabolism
- Recombinant Proteins/immunology
- Rh-Hr Blood-Group System/immunology
- Transduction, Genetic
- Tumor Cells, Cultured
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Affiliation(s)
- S Iwamoto
- Department of Legal Medicine and Human Genetics, Jichi Medical School, Tochigi, Japan.
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17
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Ichikawa N, Kitano K, Ito T, Nakazawa T, Shimodaira S, Ishida F, Kiyosawa K. Abnormal proliferation of CD4- CD8+ gammadelta+ T cells with chromosome 6 anomaly: role of Fas ligand expression in spontaneous regression of the cells. Am J Hematol 1999; 60:305-8. [PMID: 10203105 DOI: 10.1002/(sici)1096-8652(199904)60:4<305::aid-ajh9>3.0.co;2-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of granular lymphocyte proliferative disorder accompanied with hemolytic anemia and neutropenia. Phenotypes of the cells were T cell receptor gammadelta+ CD3+ CD4- CD8+ CD16+ CD56- CD57-. Southern blot analysis of T cell receptor beta and gamma chains demonstrated rearranged bands in both. Chromosomal analysis after IL-2 stimulation showed deletion of chromosome 6. Sorted gammadelta+ T cells showed an increase in Fas ligand expression compared with the levels in sorted alphabeta+ T cells. The expression of Fas ligand on these gammadelta+ T cells increased after IL-2 stimulation. The patient's anemia improved along with a decrease in granular lymphocyte count and disappearance of the abnormal karyotype without treatment. The expression of Fas ligand may be involved in spontaneous regression of granular lymphocyte proliferation with hemolytic anemia.
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MESH Headings
- Anemia, Hemolytic/genetics
- Blotting, Southern
- CD4 Antigens/analysis
- CD8 Antigens/analysis
- Chromosomes, Human, Pair 6
- Fas Ligand Protein
- Gene Deletion
- Humans
- Immunophenotyping
- Interleukin-2/pharmacology
- Karyotyping
- Killer Cells, Natural/immunology
- Lymphoproliferative Disorders/genetics
- Lymphoproliferative Disorders/pathology
- Male
- Membrane Glycoproteins/genetics
- Middle Aged
- Neutropenia/genetics
- Receptors, Antigen, T-Cell, gamma-delta/analysis
- Remission, Spontaneous
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
- T-Lymphocytes, Cytotoxic/immunology
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Affiliation(s)
- N Ichikawa
- Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano-ken, Japan
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18
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Strachan AJ, Williams B, Mohabir L, Rowe GP. Human Rh monoclonal antibodies: assessment of functional activity by chemiluminescence and RhD antibody quantitation. Transfus Clin Biol 1996; 3:483-7. [PMID: 9018813 DOI: 10.1016/s1246-7820(96)80068-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In vitro cellular assays have been described which are capable of evaluating the interactions between sensitised red cells and monocyte or K cells. The chemiluminescence assay (CL) has several advantages over other cellular assays used to assess functional activity. The CL assay unlike the ADCC assays does not require the use of radioisotopes and therefore can be easily integrated into the work of a Reference Serology laboratory. The CL assay is an objective test and not labour intensive which is the main criticism of the monocyte monolayer assay. Seventy-four monoclonal anti-Ds and 29 other Rh specificities have been evaluated by a CL assay. The use of the chemiluminescent response produced by erythrophagocytosis of sensitised red cells has been shown to correlate well with the in vivo response to red cells sensitized with polyclonal IgG antibodies. This study aimed at investigating whether the CL assay could identify and differentiate monoclonal antibodies that are capable of eliciting a response from human monocytes. Poor correlation was obtained between the CL assay results and anti-D quantitation (r = 0.236). The chemiluminescence assay discriminated between anti-D's with high quantitation levels but low predicted functional activity and anti-Ds of low quantitation levels which produced elevated CL responses. Only 3 of the 29 non-Rh D specificities tested produced a response in the CL assay emphasising the importance of specificity in the functional activity of monoclonal antibodies. The demonstration of significant differences in the functional capabilities of monoclonal antibodies has important implications for reviewing the possible use of monoclonal anti-D preparations for Rh immune prophylaxis and highlights the requirement for factors other than the antibody concentration to be examined.
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Affiliation(s)
- A J Strachan
- National Blood Transfusion Service, Rhydlafar, St Fagans, Cardiff, UK
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19
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Greenwalt TJ, Domino MM, Dumaswala UJ. An enzyme-linked antiglobulin test to quantify nanogram quantities of IgG on polystyrene microspheres. Vox Sang 1992; 63:272-5. [PMID: 1481476 DOI: 10.1111/j.1423-0410.1992.tb01234.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A method is described in which polystyrene latex beads are used for constructing standard curves to estimate the number of protein molecules on cell surfaces by an enzyme-liked immunoassay test (ELAT). A series of immune globulin (IgG) dilutions in pH 9.8 carbonate buffer were coated on 3-microns microbeads by incubation overnight at 4 degrees C and subjected to ELAT. The r value of the curve derived from four assays was 0.9991. This standard curve applied to previously recorded ELAT data resulted in estimating that normal RBC have 63 +/- 19 (SD) IgG molecules and that the lower level of sensitivity of the antiglobulin test is 155 IgG molecules per RBC. The method should be useful for more precise standardization of procedures for measuring proteins on cell surfaces.
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Affiliation(s)
- T J Greenwalt
- Hoxworth Blood Center, University of Cincinnati Medical Center, OH 45267-0055
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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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Gershon H, Sheiban E. In vitro sequestration of erythrocytes from hosts of various ages. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1991; 307:339-50. [PMID: 1805597 DOI: 10.1007/978-1-4684-5985-2_30] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Erythrocytes from young and old human donors were separated according to age-density on Stractan gradients. Old donors had more low age-density (young) erythrocytes than did young donors. Levels of IgG bound to old and young erythrocytes were determined by ELISA. Erythrocytes from old donors bore higher levels of IgG on their erythrocytes (123 +/- 55 IgG molecules per young RBC and 196 +/- 43 IgG per old RBC) than did those from young donors (58 +/- 15 IgG per young RBC and 98 +/- 20 IgG per old RBC). In an in vitro erythrophagocytosis assay, young and old erythrocytes from old donors and old erythrocytes from young donors were shown to be recognized and phagocytosed by lymphokine activated human peripheral blood monocytes. Young erythrocytes from young donors were not phagocytosed in this assay. The in vitro erythrophagocytosis of erythrocytes from old and young donors can be specifically blocked by beta-galactoside but not alpha-galactoside sugars. This phagocytosis is not blocked by Protein-G which specifically blocks Fc-gamma mediated erythrophagocytosis of Rh-D+ erythrocytes coated with IgG anti-Rh-D antibodies. beta-galactoside and alpha-galactoside sugars have no inhibitory effect on erythrophagocytosis mediated by IgG anti-Rh-D antibodies coating Rh-D+ erythrocytes. It thus appears that erythrophagocytosis of young and old erythrocytes from old donors and old erythrocytes from young donors are all mediated by a lectin-like receptor on the monocytes which recognizes beta-galactoside-like sugar moiety on the erythrocytes rather than by recognition of IgG on the erythrocyte and an Fc receptor on the macrophage. It also appears that the membrane of both young and old erythrocytes of old donors are marked for phagocytosis whereas only the old erythrocytes from young donors are so marked.
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Affiliation(s)
- H Gershon
- Department of Immunology, Technion Faculty of Medicine, Haifa, Israel
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22
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Dale GL, Daniels RB, Beckman J, Norenberg SL. Characterization of senescent red cells from the rabbit. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1991; 307:93-103. [PMID: 1805604 DOI: 10.1007/978-1-4684-5985-2_9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The above data continue to demonstrate the metabolic well being of the aged red cell as it is isolated from rabbits. The abundance of ATP, the absence of surface-bound IgG and a variety of other observations at this time lead to the tentative conclusion that the senescent red cell is amazingly healthy. Many investigators have predicted that the red cell is removed from the circulation as a metabolically exhausted effete cell. There is currently no evidence to support this other than a decrease in deformability of the cells with time, but it is not clear that this decline in deformability is sufficient to keep the cell from circulating. In either case, many of the previously proposed causes of cellular removal are clearly incorrect for the rabbit, and it is now time to focus on new directions for observing either cellular impairment or perhaps the presence of a cellular clock which is independent of the cell's metabolic state. Another point which should be addressed is the reliability of the biotinylation model in rabbits as it relates to red cells in other species. So far several observations in aged red cells isolated with valid models have been reproduced across species boundaries including the rise in ATP, the fall in AMP deaminase activity, the shift in the 4.1a to 4.1b protein ratio, the stability of a number of glycolytic enzymes, and the instability of pyrimidine 5'-nucleotidase activity. To this point, the rabbit has been a reliable model of red cell aging and one with implications for other species.
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Affiliation(s)
- G L Dale
- Department of Molecular and Experimental Medicine, Research Institute of Scripps Clinic, La Jolla, CA 92037
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23
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Abstract
Three of 46 patients with autoimmune hemolytic anemia (AIHA) satisfied the diagnostic criteria for mixed-type AIHA in which both warm-type and cold-type autoantibodies against red blood cells (RBCs) are present. The specificities of these autoantibodies were analyzed. All of the warm-type autoantibodies were IgG-chi, and the specificities were not serologically classified. The autoantibody of patient 1 reacted to the 41- and 80-kD peptides on immunoblotting, and the epitope corresponding to it was papain sensitive. Two warm-type autoantibodies from patients 2 and 3 resembled each other in serological analyses and reacted with a protease- and neuraminidase-resistant antigen. However, the antigen corresponding to the autoantibody of patient 3 was located on the 37-kD peptide by immunoprecipitation. All of the cold-type autoantibodies were IgM-cha and showed high titer and high thermal amplitude. According to the reaction pattern with untreated and enzyme-treated RBCs, the cold-type autoantibodies of patients 2 and 3 were revealed to be anti-Om and anti-I, respectively. In patient 1, the cold-type autoantibody was characterized as having high affinity for autologous RBCs, but its specificity was unclassified. The antigens corresponding to the cold-type autoantibodies were not located by immunoblotting and immunoprecipitation. These serological and immunochemical approaches to autoantibodies in mixed-type AIHA revealed that the warm and cold components recognized the different antigens.
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Affiliation(s)
- E Kajii
- Department of Forensic Medicine and Human Genetics, Tochigi, Japan
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24
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Sinha RK, Kelton JG. Current controversies concerning the measurement of platelet-associated IgG. Transfus Med Rev 1990; 4:121-35. [PMID: 2134620 DOI: 10.1016/s0887-7963(90)70257-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R K Sinha
- Department of Medicine and Pathology, McMaster University Medical Centre, Hamilton, Ontario, Canada
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25
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Atrah HI, Templeton JG, Crawford RJ, Gabra GS, Mitchell R. Passive haemagglutination inhibition for quantitation of red cell associated IgG. J Clin Pathol 1987; 40:494-9. [PMID: 3584498 PMCID: PMC1141010 DOI: 10.1136/jcp.40.5.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Passive haemagglutination inhibition (PHI) was adapted to quantitate red cell associated IgG. Twenty one patients with autoimmune haemolytic anaemia (AIHA) had a raised red cell associated IgG, mean (SD) = 5.783 (6.183) ng/10(6) red blood cell compared with that of 69 subjects with a red cell associated IgG of 0.433 (0.349) ng/10(6) red blood cell. Thirteen of 14 blood donors with a positive direct antiglobulin test (DAGT) had a normal red cell associated IgG. The only blood donor with positive DAGT and raised red cell associated IgG had AIHA. Studies of red cell associated IgG in other groups of patients were also undertaken. The technique is simple, does not require the use of sophisticated equipment, and is suitable as a routine test in hospital laboratories. The results of red cell associated IgG by PHI are reproducible and clinically relevant.
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26
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Affiliation(s)
- G Garratty
- American Red Cross Blood Services, Los Angeles-Orange Counties Region, CA 90006
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27
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Abstract
In about 20 per cent of patients taking the antihypertensive agent methyldopa, IgG autoantibodies form against red cells, but most such patients do not have hemolysis. The reason for this is uncertain; it does not appear to be explained by known characteristics of the autoantibody. Since antibody-dependent reticuloendothelial function is an important determinant of cell clearance, we measured reticuloendothelial function in nine patients taking methyldopa. We did this by measuring the rate of clearance of radiolabeled autologous red cells sensitized with anti-D alloantibody. Five patients had a positive direct antiglobulin test, and four did not. Only one patient had laboratory evidence of hemolysis. The patients without hemolysis had significantly impaired reticuloendothelial clearance. In contrast, the patient with hemolysis did not have impaired reticuloendothelial function. This study suggests that in patients taking methyldopa who have a positive direct antiglobulin test the absence of hemolysis may be caused by an impairment in reticuloendothelial function. That the drug itself may be responsible for the impairment is suggested by the occurrence of abnormal reticuloendothelial function in patients taking the drug who have a negative direct antiglobulin test.
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28
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Bareford D, Longster G, Gilks L, Tovey LA. Follow-up of normal individuals with a positive antiglobulin test. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 1985; 35:348-53. [PMID: 2932791 DOI: 10.1111/j.1600-0609.1985.tb01718.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Over a period of 20 yr (1962-1982), 67 apparently fit donors at a Regional Blood Transfusion Service were found to have an unexplained positive direct antiglobulin test (DAT). During 1983, 26 were traced and re-tested. 9 still had a positive DAT only 1 of whom had developed autoimmune haemolytic anaemia. 17 had become negative though in 7 of these an autoantibody could still be detected by an enzyme technique. Unlike patients with established autoimmune disorders, the positive DAT individuals were found to have normal T cell subsets though B cells were significantly increased.
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