[Application of the gel test using and anti-IgA antiglobulin for the immunologic diagnosis of autoimmune hemolytic anemia with a negative direct Coombs test].
Autoimmune hemolytic anemias (AIHA) are characterized by hyperhemolysis associated with the presence of the immunoglobulins IgG, IgM or IgA on the red cell membrane. These immunoglobulins react as auto-antibodies against the red cell auto-antigens of the patient. The diagnosis is supported by clinical and biological signs of hemolysis, and by the identification of the auto-antibodies using the direct antiglobulin test (DAT). Here we report 14 cases of patients who showed the clinical and biological profile of AIHA, but who gave a negative DAT. We therefore tried to determine the presence of IgA on the red cell membrane with a method more sensitive than the DAT: the gel test using anti-IgA. With such a gel test, we demonstrated that there were IgA auto-antibodies on the red cell membrane in the 14 cases, therefore confirming the diagnosis of AIHA. We discuss the interest of performing a gel test with anti-IgA in each case where AIHA is suspected, but in which a negative DAT has been observed.
Meyer
F
F
Etablissement de transfusion sanguine, Lyon, France.
Garin
L
L
Smati
C
C
Gaspard
M
M
Giannoli
C
C
Rigal
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D001327:Autoimmune Diseases / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D002648:Child; D003298:Coombs Test; D004910:Erythrocyte Membrane / Q000276:immunology*; D005188:False Negative Reactions; D005260:Female; D006462:Hemolytic Plaque Technique; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000175:diagnosis / Q000276:immunology; D012680:Sensitivity and Specificity
D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; D007070:Immunoglobulin A; C049937:anti-IgA