Severe autoimmune hemolytic anemia associated with IgM warm autoantibodies directed against determinants on or associated with glycophorin A.
OBJECTIVE
Autoimmune hemolytic anemiA (AIHA) is rarely caused by IgM warm autoantibodies, and is sometimes difficult to diagnose. We describe three patients with severe AIHA caused by IgM warm autoantibodies; in two of the three, the hemolysis was fatal.


METHODS
Conventional hematologic and serologic procedures were used.


RESULTS
The IgM autoantibodies in all three cases were directed against determinants on or associated with glycophorin A (Ena, Wrb, and Pr). The IgM autoantibodies and unusual serological characteristics, in that the agglutinins were detected or greatly enhanced only by the presence of albumin or a low pH, and/or the agglutinins reacted optimally at 20-30 degrees C.


CONCLUSIONS
IgM warm autoantibodies directed at determinants on or associated with glycophorin A appear to cause severe (often fatal) hemolytic anemia.
Garratty
G
G
American Red Cross Blood Services, Southern California Region, Los Angeles 90006, USA.
Arndt
P
P
Domen
R
R
Clarke
A
A
Sutphen-Shaw
D
D
Clear
J
J
Groncy
P
P
D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D005260:Female; D006021:Glycophorins / Q000276:immunology*; D006801:Humans; D016056:Immunodominant Epitopes; D007075:Immunoglobulin M / Q000276:immunology*; D008297:Male; D008875:Middle Aged
D001323:Autoantibodies; D006021:Glycophorins; D016056:Immunodominant Epitopes; D007075:Immunoglobulin M