A Comprehensive Diagnostic Algorithm for Direct Antiglobulin Test-Negative Autoimmune Hemolytic Anemia Reveals the Relative Ratio of Three Mechanisms in a Single Laboratory

Acta Haematologica
Toyomi Kamesaki, E Kajii

Abstract

Direct antiglobulin test (DAT)-negative warm autoimmune hemolytic anemia (AIHA) is mainly caused by three mechanisms: red blood cell (RBC)-bound immunoglobulin (Ig)G below the detection limit of routine DAT; RBC-bound IgA or IgM; or low-affinity autoantibodies. Although most cases of DAT-negative AIHA are thought to be caused by RBC-bound IgG, and combinatory serological analyses are recommended, the relative ratios of each mechanism have not been clarified. Two groups of patients with undiagnosed hemolytic anemia and negative conventional tube method-DAT (TM-DAT) were investigated using anti-IgA and anti-IgM sera, or column agglutination method-DAT (CM-DAT), respectively, in addition to radioimmunological quantitation of RBC-bound IgG. Three of 73 patients with DAT-negative AIHA showed positive RBC-bound IgA and normal amounts of RBC-bound IgG. Another group of 3 patients were RBC-bound IgM-positive, but only one of these showed normal amounts of RBC-bound IgG. In another group of patients with DAT-negative AIHA, 4 of the 20 showed positive CM-DAT and negative CM-DAT after washing RBCs. Three of these patients had normal amounts of RBC-bound IgG. Five patients with positive CM-DAT both before and after washing RBCs had high am...Continue Reading

Citations

Jul 23, 2019·American Journal of Hematology·Eri KawataZiad Solh
Mar 3, 2020·Journal of Pediatric Hematology/oncology·Machiel van den AkkerJutte van der Werf Ten Bosch
Nov 11, 2020·Journal of Veterinary Internal Medicine·Prudence L Sun, Unity Jeffery
Dec 17, 2020·Journal of Clinical Medicine·Irina Murakhovskaya
Jul 15, 2021·Clinical Case Reports·Ju Young BaeMerlin Sung Lee

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