title: Severe autoimmune hemolytic anemia associated with IgM warm autoantibodies directed against determinants on or associated with glycophorin A.
abstract: 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.
authors.affiliation: American Red Cross Blood Services, Southern California Region, Los Angeles 90006, USA.
authors.forename: G
authors.initials: G
authors.lastname: Garratty
authors.forename: P
authors.initials: P
authors.lastname: Arndt
authors.forename: R
authors.initials: R
authors.lastname: Domen
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.forename: D
authors.initials: D
authors.lastname: Sutphen-Shaw
authors.forename: J
authors.initials: J
authors.lastname: Clear
authors.forename: P
authors.initials: P
authors.lastname: Groncy
mesh_terms: 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
chemical_list: D001323:Autoantibodies; D006021:Glycophorins; D016056:Immunodominant Epitopes; D007075:Immunoglobulin M