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  • Immunohematology

 

Article | 28-April-2020

Autoimmune hemolytic anemia and a further example of autoanti-Kpb

A 65-year-old Caucasian man with myelodysplasia was admitted with autoimmune hemolytic anemia and a Hb of 5.6 g/dL. The patient’s serum contained anti-K; the DAT on the patient’s RBCs reacted 3+ with anti-IgG and 3+ with anti-C3d.K– RBC units were transfused, but there was no sustained increase in Hb level. The samples were referred to the reference laboratory of the National Blood Service. The DAT results remained the same, with anti-K detected only in the serum. An eluate

Edmond Lee, Gordon Burgess, Nay Win

Immunohematology, Volume 21 , ISSUE 3, 119–121

Article | 03-November-2020

Warm autoimmune hemolytic anemia associated with an IgM autoanti-Ge

A 28-year-old male with a prior history of Hodgkin’s disease and a recent upper respiratory tract infection presented with autoimmune hemolytic anemia (AIHA). The patient’s red blood cells (RBCs) were spontaneously agglutinated after room temperature and 37°C washes. Dithiothreitol-treated RBCs reacted strongly with anti-C3 and were nonreactive with anti-IgG, -IgM, and -IgA; they reacted with anti-IgM (κ light chains only) by flow cytometry. The patient’s serum was

Thom S. Sererat, Douglas W. Veidt, Patricia A. Arndt, George Garratty

Immunohematology, Volume 14 , ISSUE 1, 26–29

Article | 09-November-2020

Direct Coombs test-negative autoimmune hemolytic anemia and low-affinity IgG class antibodies

Autoimmune hemolytic anemia, in which the direct antiglobulin test (DAT) is negative or weakly positive, may be due to low-affinity autoantibodies. We describe two such cases. An 8-year-old male presented with weight loss, jaundice, a hemoglobin of 33 g/L, reticulocytes of 306 x 109/L, and haptoglobin of < 0.1 g/L. The DAT was negative. After washing the red blood cells (RBCs) with saline at 4°C, the DAT was positive for IgG and an eluate contained an IgG3 autoantibody, thus confirming a

R.J. Sokol, D.J. Booker, R. Stamps, S. Jalihal, B. Paul

Immunohematology, Volume 13 , ISSUE 4, 115–118

Case report | 01-December-2019

A case of autoimmune hemolytic anemia with anti-D specificity in a 1-year-old child

Although antibodies to antigens in the Rh blood group system are common causes of warm autoimmune hemolytic anemia, specificity for only the D antigen is rare in autoimmune hemolysis in pediatric patients. This case reports an anti-D associated with severe hemolytic anemia (Hb = 2.1 g/dL) in a previously healthy 14-month-old child who presented with a 3-day history of low-grade fevers and vomiting. Because of his severe anemia, on admission to the hospital he was found to have altered mental

Rachel S. Bercovitz, Margaret Macy, Daniel R. Ambruso

Immunohematology, Volume 29 , ISSUE 1, 15–18

Article | 14-October-2020

Warm autoimmune hemolytic anemia with mimicking anti-c and -E specificities

increased and stable hemoglobin. It was concluded that the autoantibody had mimicking anti-c and -E specificities. This is a report of an unusual case of autoimmune hemolytic anemia because the Rh autoantibody appeared to have dual mimicking specificities, and the patient’s RBCs were antigen negative for one of the antibody specificities, i.e., anti-E.

Hsin-Yeh Hsieh, Diana L. Moroney, Deanne E. Naumann, D. Jane Hata, Nancy C. Vosnidou, Rovenna L. Kessinger, Nassir Shahab, Nasrollah Hakami, Daniel S. Smith

Immunohematology, Volume 18 , ISSUE 1, 19–22

Article | 03-November-2020

Autoimmune hemolytic anemia caused by warm-reacting IgM-class antibodies

Warm IgM autoantibodies occur in association with IgG-class and/or IgA-class immunoglobulins in approximately 30 percent of patients with warm-type autoimmune hemolysis. They may be classified as agglutinins or hemolysins, which may be incomplete or complete, depending on in vitro serology; they almost always bind complement. Autoimmune hemolytic anemia solely due to warm IgM autoantibodies is exceedingly rare. We report two cases of the incomplete agglutinin type. The autoantibodies were

R.J. Sokol, D.J. Booker, R. Stamps, S. Sobolewski, A.P. Haynes

Immunohematology, Volume 14 , ISSUE 2, 53–58

Case report | 09-October-2019

Autoanti-C in a patient with primary sclerosing cholangitis and autoimmune hemolytic anemia: a rare presentation

Primary sclerosing cholangitis (PSC) is rarely associated with autoimmune hemolytic anemia (AIHA), and the presence of  specific autoantibodies has not been reported previously. We present a unique case report of PSC associated with AIHA implicating autoanti-C. A 17-year-old girl was admitted to our hospital with PSC along with AIHA. Her blood sample demonstrated a positive direct antiglobulin test and a positive autocontrol in the antihuman globulin phase, confirming the patient had warm

Meenu Bajpai, Ashish Maheshwari, Shruti Gupta, Chhagan Bihari

Immunohematology, Volume 32 , ISSUE 3, 104–107

Article | 14-October-2020

Clinically significant autoimmune hemolytic anemia with a negative direct antiglobulin test by routine tube test and positive by column agglutination method

In two to five percent of cases of autoimmune hemolytic anemia (AIHA),the patient’s RBCs are negative in the direct antiglobulin test (DAT). We describe a patient with AIHA with a negative DAT when tested by the traditional tube test but with a strongly positive one when tested by column agglutination. When the DAT was repeated by tube test using 4°C saline washes, it became positive. This phenomenon has been observed when low-affinity antibodies are involved in AIHA. The patient

Marco Lai, Carlo Rumi, Giuseppe D’Onofrio, Maria Teresa Voso, Giuseppe Leone

Immunohematology, Volume 18 , ISSUE 4, 109–113

Article | 14-October-2020

Quantitation of red cell–bound IgG, IgA, and IgM in patients with autoimmune hemolytic anemia and blood donors by enzymelinked immunosorbent assay

This paper describes an enzyme immunoassay for the quantitative determination of IgG, IgA, and IgM immunoglobulins on RBCs. Ether eluates made from RBCs were followed by an enzyme-linked immunosorbent assay of immunoglobulin concentration. Calibration curves were derived from immunoglobulin standards and the number of molecules of each isotype per RBC was calculated. The assay was carried out in 200 healthy blood donors and 62 patients with warm autoimmune hemolytic anemia (AIHA), two of them

Antonio A. Bencomo, Martha Díaz, Yalile Alfonso, Odalys Valdés, María E. Alfonso

Immunohematology, Volume 19 , ISSUE 2, 47–53

Review | 01-April-2020

Review: Pharmacologic treatment of warm autoimmune hemolytic anemia

The clinical course of warm autoimmune hemolytic anemia (WAIHA) can be perplexing and frustrating. Although many patients respond to standard therapy in a predictable and timely fashion, some patients are refractory to standard therapy and may require several attempts of therapies that are less well established. The focus of this review is to discuss the various pharmacologic approaches and options for the treatment of WAIHA.

Karen E. King

Immunohematology, Volume 23 , ISSUE 3, 120–129

Article | 10-November-2020

Autoimmune hemolytic anemia due to IgA class autoantibodies

Autoimmune hemolytic anemia due to warm-reacting autoantibod­ies solely of the IgA class is very rare, and only five cases were iden­tified among 5,177 patients referred during 13.5 years. All were females (ages 21-69 years) and all presented with idiopathic “Coombs negative’ autoimmune hemolytic anemia, a diagnosis that was confirmed using monospecific anti-human IgA reagents. Red cell-bound IgG was reduced, but in two patients IgM was initially increased, an occurrence

R.J Sokol, D.J Booker, R. Stamps, J.R. Booth

Immunohematology, Volume 12 , ISSUE 1, 14–19

Article | 22-January-2021

A case of megaloblastic anemia simulating a cold autoimmune hemolytic anemia

Cold autoimmune hemolytic anemia (cAIHA) is an autoimmune hemolytic anemia mediated by cold agglutinins, which are mostly specific for the I antigen. Autoanti-I may be detected in patients with cAIHA as well as in healthy individuals. Cold agglutinins belong to the immunoglobulin M (IgM) subclass and, in the majority of patients with primary cAIHA, are monoclonal IgM-kappa antibodies. Primary cAIHA is most often seen in elderly patients (median age at onset is 67 years [range 30–92 years]), and

R. De La Puerta, N. Carpio, G. Sanz, P. Solves

Immunohematology, Volume 36 , ISSUE 3, 89–92

Article | 10-November-2020

Leukocyte reduction of red cells when transfusing patients with autoimmune hemolytic anemia: a strategy to decrease the incidence of confounding transfusion reactions

Autoimmune hemolytic anemia (AIHA) presents a difficult challenge to clinicians and blood bankers alike. Autoantibodies in the serum significantly complicate serologic evaluation, and necessitate performing procedures such as adsorptions to eliminate the possibility of underlying alloantibodies. In many instances the blood that is issued may be phenotypically similar but remains crossmatch incompatible, generating a considerable degree of anxiety among the clinical staff who are responsible for

Jeanne A. Lumadue, Rosetta Sue Shirey, Thomas S. Kickler, Paul M. Ness

Immunohematology, Volume 12 , ISSUE 2, 84–86

Article | 21-April-2020

Severe hemolytic anemia due to auto anti-N

Auto anti-N is infrequently encountered and, in most reported cases,does not cause clinical hemolysis. This case reports an auto anti-N associated with severe hemolytic anemia (Hb = 2.7 g/dL) in a 6-year-old Caucasian girl with a history of vomiting, fever, and abdominal pain. Upon admission, she was found to have a metabolic acidosis,secondary to her severe anemia,with abnormal liver function tests. As in three other case reports,the autoimmune hemolytic anemia resolved,with disappearance of

Caroline C. Immel, Myra McPherson, Shauna N. Hay, Linda R. Braddy, Mark E. Brecher

Immunohematology, Volume 21 , ISSUE 2, 63–65

Article | 31-December-2020

Cold Autoimmune Hemolytic Anemia With Auto-Anti-AI Specificity: 51Chromium Studies

A 65-year-old woman was found to have severe autoimmune hemolytic anemia. The patient was group A1, RhoD positive. The direct antiglobulin test was strongly positive with anti-C3 and negative with anti-IgG. The serum contained two distinct IgM antibodies, auto-anti-I and auto-anti-AI. Both were reactive at 22°C. However, the anti-AI also was reactive in saline and in albumin at 37°C. An eluate revealed anti-AI and a weak anti-I. Sequential 51Chromium survival studies were done with

May H. McGinniss, Richard J. Davey, Richard A. Binder, Arthur N. Kales

Immunohematology, Volume 3 , ISSUE 2, 20–22

Case report | 20-December-2020

A case report: IgG autoanti-N as a cause of severe autoimmune hemolytic anemia

anti-N activity, and radioimmunoassay with monoclonal anti-IgG was strongly positive, indicating that both the cold- and the warm-reacting anti-N reactivity resided in the IgG fraction. The patient was treated with N - ‘N’ + red cell transfusions, prednisone, and azathioprine and gradually became transfusion independent. Postrecovery typing revealed her red cells to be M+N+S+s+. This constitutes the third case of autoimmune hemolytic anemia associated with IgG autoanti-N. The marked

Martha Rae Combs, Marilyn J. Telen, Sharon E. Hall, Wendell F. Rosse

Immunohematology, Volume 6 , ISSUE 4, 83–86

Report | 29-October-2019

Demonstration of IgG subclass (IgG1 and IgG3) in patients with positive direct antiglobulin tests

Serologic characterization of autoantibodies helps in the management and monitoring of the course of autoimmune hemolytic anemia (AIHA). The purpose of this study was to evaluate gel centrifugation test (GCT) cards for immunoglobulin G (IgG) titer and determination of IgG subclasses IgG1 and IgG3 and their influence on hemolysis. Eighty direct antiglobulin test (DAT)-positive patients were examined with the help of GCT cards for IgG titer and IgG subclasses. The results were correlated with the

Ashutosh Singh, Archana Solanki, Rajendra Chaudhary

Immunohematology, Volume 30 , ISSUE 1, 24–27

Report | 14-March-2020

Attempts to support an immune etiology in 800 patients with direct antiglobulin test–negative hemolytic anemia

Clinical and hematologic evidence of warm autoimmune hemolytic anemia (AIHA) is present in some patients whose direct antiglobulin test (DAT) is negative. The most common causes for AIHA associated with a negative DAT are RBC-bound IgG below the sensitivity threshold of the DAT, RBC-bound IgA and IgM not detectable by routine reagents, and low-affinity IgG that dissociates during the testing process. Samples submitted from 800 patients with hemolytic anemia and a negative DAT were tested by an

Regina M. Leger, Asuncion Co, Penny Hunt, George Garratty

Immunohematology, Volume 26 , ISSUE 4, 156–160

Article | 01-April-2020

Application of gel technology in the serologic characterization of autoantibody in DAT-positive autoimmune diseases

used to characterize the RBC-bound autoantibodies in 66 DAT-positive patients. Hematologic and biochemical parameters such as Hb,reticulocyte count, serum bilirubin, and serum LDH were obtained from the patient files. Of the 49 patients carrying IgG on their RBCs, 21 (42.8%) were suffering from connective tissue disorders and another 16 patients (32.7%) had autoimmune hemolytic anemia. A total of 19 of these 49 patients had evidence of hemolysis. Thirteen of the 17 patients (76.5%) whose RBCs were

Sudipta Sekhar Das, Rajendra K. Chaudhary

Immunohematology, Volume 23 , ISSUE 2, 59–62

Article | 18-October-2020

Quantitation of red cell-bound immunoglobulins and complement in lymphoma patients

Quantitative ELISA may be useful for determining the amount of red blood cell (RBC)-associated immunoglobulins (Igs) in patients with autoimmune hemolytic anemia (AIHA). In idiopathic AIHA, there is about 20 times more RBC-associated IgG and complement than in normal persons. In patients with low-grade lymphomas (particularly, B-CLL and splenic marginal zone lymphoma) autoimmune hemolysis is a component of their anemia. In highgrade malignant lymphomas (i.e, diffuse large B-cell lymphoma and

M. Podberezin, A. Levina, L. Romanova, O. Margolin, O. Nasibov, A.V. Pivnik

Immunohematology, Volume 16 , ISSUE 4, 147–153

Case report | 16-May-2020

Case report: exacerbation of hemolytic anemia requiring multiple incompatible RBC transfusions

RBC transfusions in a patient with a history of autoimmune hemolytic anemia (AIHA) can represent both a laboratory and a clinical challenge. The development of high-titer low-avidity antibodies and antibodies to high-frequency antigens may further impair the ability to identify compatible donor RBCs. Not infrequently, incompatible RBCs must be used and the desire to increase oxygen carrying capacity conflicts with the desire to avoid exacerbating the autoimmune hemolytic process with RBC

Annika M. Svensson, Sharon Bushor, Mark K. Fung

Immunohematology, Volume 20 , ISSUE 3, 177–183

Review | 28-April-2020

Review: complement receptor 1 therapeutics for prevention of immune hemolysis

The complement system plays a crucial role in fighting infections and is an important link between the innate and adaptive immune responses. However, inappropriate complement activation can cause tissue damage, and it underlies the pathology of many diseases. In the transfusion medicine setting, complement sensitization of RBCs can lead to both intravascular and extravascular destruction. Moreover, complement deficiencies are associated with autoimmune disorders, including autoimmune hemolytic

Karina Yazdanbakhsh

Immunohematology, Volume 21 , ISSUE 3, 109–118

Article | 06-December-2020

Clinical correlation of positive direct antiglobulin tests in patients with sickle cell disease

Serologic findings of immune-mediated hemolytic anemia (autoimmune hemolytic anemia and cold agglutinin disease) are not infrequent in patients with sickle cell disease and can be clinically significant. Features of sickle cell disease that may affect the emergence and intensity of immune-mediated hemolysis include the antigenic stimulation of chronic red blood cell (RBC) transfusions, increased autoantibody production, RBC membrane defects, and functional asplenism. We describe two patients

Raymond L. Comenzo, Marie E. Malachowski, Eugene M. Berkman

Immunohematology, Volume 8 , ISSUE 1, 13–16

Case report | 29-October-2019

Evans syndrome in a pediatric liver transplant recipient with an autoantibody with apparent specificity for the KEL4 (Kpb) antigen  

Scott A. Koepsell, Kerry Burright-Hittner, James D. Landmark

Immunohematology, Volume 30 , ISSUE 1, 14–17

Article | 03-November-2020

Paroxysmal cold hemoglobinuria and the elusive DonathLandsteiner antibody

R.J. Sokol, D.J. Booker, R. Stamps

Immunohematology, Volume 14 , ISSUE 3, 109–112

Article | 17-November-2020

A simple screening method to evaluate the presence of alloantibodies with concomitant warm autoantibodies

Autoantibodies are present in the serum of patients with autoimmune hemolytic anemia. Extensive serologic investigation is often needed to determine if alloantibodies are also present. To aid in the investigation, a simple method of serum dilution is described. The serum dilution method was compared to allogeneic red blood cell adsorptions in 119 cases tested over a two-year period. In 20 percent of the cases, the same underlying alloantibodies were detected by both the serum dilution method

Ragnhild Øyen, Maria L. Angeles

Immunohematology, Volume 11 , ISSUE 3, 85–87

Article | 16-October-2019

Warm autoadsorption using ZZAP

Farai M. Tsimba-Chitsva, Amy Caballero, Becky Svatora

Immunohematology, Volume 34 , ISSUE 1, 1–3

Article | 09-November-2020

A maternal warm-reactive autoantibody presenting as a positive direct antiglobulin test in a neonate

Autoimmune hemolytic anemia in pregnancy is a rare cause of hemolytic disease of the newborn. This report describes a neonate with a mild hemolytic process and a positive direct antiglobulin test (DAT) presenting as the first manifestations of a maternal warm-reactive autoantibody. A full-term male neonate, blood group O, had a strongly positive DAT and laboratory evidence suggestive of a mild hemolytic process. The neonate’s mother was also group O and had a negative antibody screen

Terry D. Williamson, Linda H. Liles, Douglas P. Blackall

Immunohematology, Volume 13 , ISSUE 1, 6–8

Report | 06-November-2019

Drug-induced immune hemolytic anemia: the last 30 years  of changes

, such as which drugs most commonly cause DIIHA, the optimal testing methods for identifying them, and the theories behind the mechanisms by which they react. This article reviews the major changes in DIIHA since the early 1980s involving the immune complex mechanism, cephalosporins, nonimmunologic protein adsorption, and penicillins. Because serologic results associated with DIIHA can mimic those expected with autoimmune hemolytic anemia or hemolytic transfusion reactions, DIIHA may go undetected in

Patricia A. Arndt

Immunohematology, Volume 30 , ISSUE 2, 44–54

Letter to Editor | 31-December-2020

Letter to the Editor: Anto-Anti-AI in the Serum of a Patient With Fatal Autoimmune Hemolytic Anemia

Mary H. McGinniss

Immunohematology, Volume 3 , ISSUE 2, 23–24

Letter to Editor | 31-December-2020

Letter to the Editor: Preparation of a Simulated Warm Autoimmune Hemolytic Anemia Specimen for Instructional Purposes in Blood Banking

Patricia Callicoat, Deborah Sturdivant

Immunohematology, Volume 3 , ISSUE 2, 24–24

Report | 09-October-2019

A detailed flow cytometric method for detection of low-level in vivo red blood  cell–bound IgG, IgA, and IgM

Wendy Beres, Geralyn M. Meny, Sandra Nance

Immunohematology, Volume 32 , ISSUE 4, 161–169

Article | 09-November-2020

Measurement of red blood cell-bound C3b and C3d using an enzyme-linked direct antiglobulin test

Complement has a complex role in immune mediated red blood cell (RBC) destruction and usually induces extravascular hemolysis of C3bcoated RBCs by erythrophagocytosis and by acting synergistically with cell-bound immunoglobulins. A sensitive two-stage enzyme-linked direct antiglobulin test (ELDAT) was developed and used to measure RBC-bound C3b and C3d in 120 healthy adult individuals and in 60 patients suffering from a variety of conditions, including warm- and cold-type autoimmune hemolytic

J.D. Bellamy, D.J. Booker, N.T. James, R. Stamps, R.J. Sokol

Immunohematology, Volume 13 , ISSUE 4, 123–131

Article | 18-October-2020

Frequency of HLA-DQB*06 in Caucasian, African American, and Mexican American patients with a positive direct antiglobulin test

Joann M. Moulds, Laura A. Diekman, T. Denise Wells, John D. Reveille

Immunohematology, Volume 16 , ISSUE 2, 74–77

Article | 06-December-2020

Serologic investigation of fatal hemolytic anemia associated with a multiple drug history and Rh-like autoantibody

with drug-coated cells. Because of the patient's complex medical history, it was not possible to attribute the fatal autoimmune hemolytic anemia solely to drug antibody.

Nancy I. Maddox, Debra Futral, Floyd T. Boudreau

Immunohematology, Volume 8 , ISSUE 3, 70–76

Article | 15-April-2020

Efficacy of murine monoclonal antibodies in RBC phenotyping of DAT-positive samples

direct agglutination of the sensitized RBCs was obtained.This study demonstrates the value of using murine monoclonal antibodies to determine the phenotype of RBCs with a positive DAT caused by autoantibodies (e.g., in autoimmune hemolytic anemia) and supports previous studies showing that RBCs sensitized in vivo can be typed without chemical manipulation.

Edmond Lee, Kevin Hart, Gordon Burgess, Gregory R. Halverson, Marion E. Reid

Immunohematology, Volume 22 , ISSUE 4, 161–165

Article | 22-November-2020

An improved method for removal of red cell-bound immunoglobulin using chloroquine solution

In some patients with autoimmune hemolytic anemia or hemolytic disease of the newborn, the red cells are so heavily coated with immunoglobulin that phenotyping cannot be carried out unless the antibody is removed without destroying the red cell antigens. Studies were performed initially to determine the optimum conditions for removal of immunoglobulin from red blood cells (RBCs) using chloroquine. Group O, R1r RBCs were coated with serial dilutions of anti-D; aliquots were incubated in

Angela E. Beaumont, R. Stamps, D.J. Booker, R.J. Sokol

Immunohematology, Volume 10 , ISSUE 1, 22–24

Report | 26-October-2019

Clinical and reference lab characteristics of patients with suspected direct antiglobulin test (DAT)-negative immune hemolytic anemia

Clinical evidence of warm autoimmune hemolytic anemia is present in 1 percent to 10 percent of patients whose direct antiglobulin test (DAT) is negative. The clinical underpinnings associated with DAT-negative immune hemolysis are poorly understood, and the current study aimed to further define the clinical characteristics associated with this form of anemia. A 19-question survey, requesting clinical information about each patient, was retrospectively mailed to all referring labs that had sent

Matthew S. Karafin, Gregory A. Denomme, Michael Schanen, Jerome L. Gottschall

Immunohematology, Volume 31 , ISSUE 3, 108–115

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