Immune hemolysis-serological and clinical aspects.
The differential diagnosis of anemia must consider immune hemolytic anemias as a frequent cause. Whereas detection of anti-red blood cell (RBC) alloantibodies frequently induced by immunogenic stimuli (transfusion, pregnancy) is performed by routine serology, diagnosing autoimmune hemolytic anemias or drug-induced hemolytic anemias remains a challenge, usually requiring close collaboration of a number of disciplines. Positive direct antiglobulin test (Coombs' test) represents a central criterion in diagnosing immune hemolytic anemias, leading to further detailed analyses. The most-severe type of immune-mediated hemolysis is acute intravascular hemolysis after ABO incompatible RBC transfusion. This review highlights underlying biochemical aspects, immunohematological diagnostics, and the clinical relevance of RBC allo- and autoantibodies, including paroxysmal nocturnal hemoglobinemia and drug-induced hemolysis. Finally, current and partly experimental therapeutic strategies of immune hemolytic anemias are summarized.
Institute for Transfusion Medicine, University Hospital Charité, Medical Faculty of the Humboldt-University of Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany. axel.pruss@charite.de
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Pruss
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Salama
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Ahrens
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Hansen
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Kiesewetter
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Koscielny
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Dörner
D000017:ABO Blood-Group System / Q000276:immunology; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000209:etiology* / Q000628:therapy; D004912:Erythrocytes / Q000276:immunology; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications; D006801:Humans; D007518:Isoantibodies / Q000276:immunology; D012204:Rh-Hr Blood-Group System / Q000276:immunology
D000017:ABO Blood-Group System; D007518:Isoantibodies; D012204:Rh-Hr Blood-Group System