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17-06-2024 | Autoimmune Hemolytic Anemia | ORIGINAL ARTICLE

Insight Into Aetiology and Severity of Hemolysis Associated with Immunoproteins on Red Cell Surface in Direct Antiglobulin Test Positive Auto-immune Hemolytic Anemia

Authors: Suhasini Sil, Daljit Kaur, Gita Negi, Ashish Jain, Uttam Kumar Nath

Published in: Indian Journal of Hematology and Blood Transfusion

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Abstract

The study aimed to find out the correlation of positive direct antiglobulin test (DAT) with features of autoimmune hemolysis in patients presenting to a tertiary care center in Northern India. Patient history, lab findings, and immune-hematological findings which can influence the management of patients with auto-immune hemolytic anemia were studied. DAT helps to differentiate immune hemolysis from non-immune hemolysis in patients with hemolytic anemia. A prospective study over 18 months was performed on DAT-positive samples of patients showing features of auto-immune hemolysis. The laboratory markers of hemolysis were correlated with immune-hematological studies like elution-adsorption, antibody specificity, and titer. Out of 1371 requests received for Immuno-hematological workup of patients with hemolysis, 92 (6.71%) met the inclusion criteria. Thirty (32.6%) patients were diagnosed with primary (Idiopathic) Auto-immune Hemolytic Anemia (AIHA), and the remaining 62(67.3%) patients had secondary AIHA. The gender distribution in primary AIHA was male: female as 1:2.7, while in secondary AIHA it was observed as male: female to be 1:1.3.The median age for primary AIHA was found to be 23.7 years (range 1 year to 48 years), and for secondary AIHA it was found to be 44.6 years (range 2 to 85 years). Of all AIHA patients tested, 85.8% showed the presence of warm autoantibodies in their sera while 7.6% had mixed-type AIHA and the remaining 6.5% had cold autoantibodies. The study highlights a strong association between higher strength of DAT positivity, multiple antibodies/immunoglobulins with complements coating red cells, and a higher titer of IgG and IgG1 & IgG3 subclass with the severity of hemolysis.
Literature
1.
go back to reference Garrity G (1988) The clinical significance (and insignificance) of red-cell-bound IgG and complement. Current application and interpretation of the direct antiglobulin test. American Association of Blood Banks, Arlington Garrity G (1988) The clinical significance (and insignificance) of red-cell-bound IgG and complement. Current application and interpretation of the direct antiglobulin test. American Association of Blood Banks, Arlington
2.
go back to reference Michel M (2011) Classification and therapeutic approaches in autoimmune hemolytic anemia: an update. Expert Rev Hematol 4(6):607–618CrossRefPubMed Michel M (2011) Classification and therapeutic approaches in autoimmune hemolytic anemia: an update. Expert Rev Hematol 4(6):607–618CrossRefPubMed
3.
go back to reference Harmening DM, Prihoda LA, Green RE (1999) Autoimmune hemolytic anemia. Modern Blood Bank Transf Pract 6:446–447 Harmening DM, Prihoda LA, Green RE (1999) Autoimmune hemolytic anemia. Modern Blood Bank Transf Pract 6:446–447
4.
go back to reference Sokol RJ, Hewitt S, Stamps BK (1981) Autoimmune haemolysis: an 18-year study of 865 cases referred to a regional transfusion centre. Br Med J (Clin Res Ed) 282(6281):2023–2027CrossRefPubMed Sokol RJ, Hewitt S, Stamps BK (1981) Autoimmune haemolysis: an 18-year study of 865 cases referred to a regional transfusion centre. Br Med J (Clin Res Ed) 282(6281):2023–2027CrossRefPubMed
5.
go back to reference Hansen DL, Möller S, Andersen K, Gaist D, Frederiksen H (2020) Increasing incidence and prevalence of acquired hemolytic Anemias in Denmark, 1980–2016. ClinEpidemiol 12:497–508 Hansen DL, Möller S, Andersen K, Gaist D, Frederiksen H (2020) Increasing incidence and prevalence of acquired hemolytic Anemias in Denmark, 1980–2016. ClinEpidemiol 12:497–508
6.
go back to reference Das SS, Zaman RU, Safi M (2014) Incompatible blood transfusion: challenging yet lifesaving in the management of acute severe autoimmune hemolytic anemia. Asian J Transfus Sci 8(2):105–108CrossRefPubMedPubMedCentral Das SS, Zaman RU, Safi M (2014) Incompatible blood transfusion: challenging yet lifesaving in the management of acute severe autoimmune hemolytic anemia. Asian J Transfus Sci 8(2):105–108CrossRefPubMedPubMedCentral
8.
go back to reference Fung KM, Eder A, Spitalnik SL, Westhoff Connie M (2020) AABB technical manual, 19th edn. American Association of Blood Bank, Bethesda Fung KM, Eder A, Spitalnik SL, Westhoff Connie M (2020) AABB technical manual, 19th edn. American Association of Blood Bank, Bethesda
9.
go back to reference Das SS, Nityanand S, Chaudhary R (2009) Clinical and serological characterisationof autoimmune hemolytic anemia in a tertiary care hospital in North India. AnnHematol 88(8):727–732 Das SS, Nityanand S, Chaudhary R (2009) Clinical and serological characterisationof autoimmune hemolytic anemia in a tertiary care hospital in North India. AnnHematol 88(8):727–732
10.
go back to reference Wikman A, Axdorph U, Gryfelt G, Gustafsson L, Björkholm M, Lundahl J (2005) Characterization of red cell autoantibodies in consecutive DAT-positive patients with relation to in vivo haemolysis. Ann Hematol 84(3):150–158CrossRefPubMed Wikman A, Axdorph U, Gryfelt G, Gustafsson L, Björkholm M, Lundahl J (2005) Characterization of red cell autoantibodies in consecutive DAT-positive patients with relation to in vivo haemolysis. Ann Hematol 84(3):150–158CrossRefPubMed
11.
go back to reference Wheeler CA, Calhoun L, Blackall DP (2004) Warm reactive autoantibodies: clinical and serologic correlations. Am J Clin Pathol 122(5):680–685CrossRefPubMed Wheeler CA, Calhoun L, Blackall DP (2004) Warm reactive autoantibodies: clinical and serologic correlations. Am J Clin Pathol 122(5):680–685CrossRefPubMed
12.
go back to reference Mollison PL, Engelfriet CP, Contreras M (1997) Blood transfusion in clinical medicine, 10th edn. Blackwell, Oxford, pp 271–272 Mollison PL, Engelfriet CP, Contreras M (1997) Blood transfusion in clinical medicine, 10th edn. Blackwell, Oxford, pp 271–272
13.
go back to reference Klein NP, Ray P, Carpenter D, Hansen J, Lewis E, Fireman B et al (2010) Rates of autoimmune diseases in Kaiser Permanente for use in vaccine adverse event safety studies. Vaccine 28(4):1062–1068CrossRefPubMed Klein NP, Ray P, Carpenter D, Hansen J, Lewis E, Fireman B et al (2010) Rates of autoimmune diseases in Kaiser Permanente for use in vaccine adverse event safety studies. Vaccine 28(4):1062–1068CrossRefPubMed
14.
go back to reference Bottiger LE, Westerholm B (1973) Acquired haemolytic anaemia. I: Incidence andaetiology. Acta Med Scand 193:223–226CrossRefPubMed Bottiger LE, Westerholm B (1973) Acquired haemolytic anaemia. I: Incidence andaetiology. Acta Med Scand 193:223–226CrossRefPubMed
15.
16.
go back to reference Shulman IA, Branch DR, Nelson JM, Thompson JC, Saxena S, Petz LD (1985) Autoimmune hemolytic anemia with both cold and warm autoantibodies. JAMA 253(12):1746–1748CrossRefPubMed Shulman IA, Branch DR, Nelson JM, Thompson JC, Saxena S, Petz LD (1985) Autoimmune hemolytic anemia with both cold and warm autoantibodies. JAMA 253(12):1746–1748CrossRefPubMed
17.
go back to reference Dausset J, Colombani J (1959) The serology and the prognosis of 128 cases of autoimmune hemolytic anemia. Blood 14:1280–1301CrossRefPubMed Dausset J, Colombani J (1959) The serology and the prognosis of 128 cases of autoimmune hemolytic anemia. Blood 14:1280–1301CrossRefPubMed
18.
go back to reference Zantek ND, Koepsell SA, Tharp DR Jr, Cohn CS (2012) The direct antiglobulin test: a critical step in the evaluation of hemolysis. Am J Hematol 87(7):707–709CrossRefPubMed Zantek ND, Koepsell SA, Tharp DR Jr, Cohn CS (2012) The direct antiglobulin test: a critical step in the evaluation of hemolysis. Am J Hematol 87(7):707–709CrossRefPubMed
19.
go back to reference Kavitha G, Latha B, Hamsavardhini S (2021) Evaluation of DAT positive AIHA cases by elution study at a tertiary care centre in South India. GSC Biol Pharm Sci 15(3):041–051CrossRef Kavitha G, Latha B, Hamsavardhini S (2021) Evaluation of DAT positive AIHA cases by elution study at a tertiary care centre in South India. GSC Biol Pharm Sci 15(3):041–051CrossRef
20.
go back to reference Lynen R, Krone O, Legelar TJ, Köhler M, Mayer WR (2002) A newly developed gel centrifugation test for quantification of RBCbound IgG antibodies and their subclasses IgG1 and IgG3: comparison with flow cytometry. Transfusion 42:612–618CrossRefPubMed Lynen R, Krone O, Legelar TJ, Köhler M, Mayer WR (2002) A newly developed gel centrifugation test for quantification of RBCbound IgG antibodies and their subclasses IgG1 and IgG3: comparison with flow cytometry. Transfusion 42:612–618CrossRefPubMed
21.
go back to reference Arora S, Dua S, Radhakrishnan N, Singh S, Madan J, Nath D (2021) Autoimmune hemolytic anemia in children: clinical presentation and treatment outcome. Asian J Transf Sci 15(2):160CrossRef Arora S, Dua S, Radhakrishnan N, Singh S, Madan J, Nath D (2021) Autoimmune hemolytic anemia in children: clinical presentation and treatment outcome. Asian J Transf Sci 15(2):160CrossRef
22.
go back to reference Johnson ST, Puca KE (2022) Evaluating patients with autoimmune hemolytic anemia in the transfusion service and immunohematology reference laboratory: pretransfusion testing challenges and best transfusion-management strategies. Hematol Am Soc Hematol Educ Program 2022(1):96–104CrossRef Johnson ST, Puca KE (2022) Evaluating patients with autoimmune hemolytic anemia in the transfusion service and immunohematology reference laboratory: pretransfusion testing challenges and best transfusion-management strategies. Hematol Am Soc Hematol Educ Program 2022(1):96–104CrossRef
Metadata
Title
Insight Into Aetiology and Severity of Hemolysis Associated with Immunoproteins on Red Cell Surface in Direct Antiglobulin Test Positive Auto-immune Hemolytic Anemia
Authors
Suhasini Sil
Daljit Kaur
Gita Negi
Ashish Jain
Uttam Kumar Nath
Publication date
17-06-2024
Publisher
Springer India
Published in
Indian Journal of Hematology and Blood Transfusion
Print ISSN: 0971-4502
Electronic ISSN: 0974-0449
DOI
https://doi.org/10.1007/s12288-024-01805-y