Influence of immunohematological markers on severity of in vivo hemolysis in human warm autoimmune haemolytic anemia |
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| Institution: | 1. Malatya Training and Research Hospital, Department of Hematology, Malatya, Turkey;2. ?nönü University, Turgut Özal Medical Center, Adult Hematology Department, Malatya, Turkey;3. Inonu University, Turgut Özal Medical Center, Department of Internal Medicine, Malatya, Turkey;4. K?r?ehir Training and Research Hospital, Pharmacist K?r?ehir, Turkey;5. F?rat University, Department of Internal Medicine, Adult Hematology Department, Elaz??, Turkey;1. Institute of Clinical Blood Transfusion, Guangzhou Blood Center, Guangzhou, China;2. The Key Medical Laboratory of Guangzhou, Guangzhou, China;3. Department of Blood Transfusion, Affiliated Tungwah Hospital of Sun Yat-Sen University, Dongguan, China;4. Department of Blood Transfusion, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China;5. Dongguan Central Blood Station, Dongguan, China;1. Department of Blood Transfusion, The Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong 226001, China;2. Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong 226001, China;1. Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion, Crete, Greece;2. Public Health & Vaccines Lab. Department of Nursing - School of Health Sciences University of Thessaly, 41500 Larissa, Greece;3. Fourth Local Health Team - Academic Unit of Heraklion, Crete, Greece;4. Department of Hygiene and Epidemiology, Medical Faculty, School of Health Science, University of Thessaly, 41100 Larissa, Greece |
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| Abstract: | Autoantibody production in autoimmune haemolytic anemia (AIHA) is the result of the loss of self-immunological tolerance of the host. Here we investigated the various immunohematological markers that may influence the severity of in vivo hemolysis in warm AIHA (WAIHA). Complete direct antiglobulin test (DAT) evaluation and immunohematological characterization were performed in 247 patients of WAIHA following departmental protocols. Clinical and laboratory details of patients were obtained from patient file. The median age of WAIHA patients was 47 years with a female preponderance. Lymphoproliferative diseases were the major underlying causes of secondary WAIHA. The mean haemoglobin (Hb) and reticulocyte count (Retic) were 6.43 gm/dL and 7.58% respectively. Single autoantibody bound to red cells was investigated in 151 patients. The main IgG subclass was IgG1. Multiple autoantibodies like IgG+ C, IgG+IgA and IgG+IgA+C were found in 87 (35.2%) patients. Free autoantibodies were observed in 112 patients with a median indirect antiglobulin test (IAT) reactivity of 2+. Derangement of haematological and biochemical values was statistically significant with increase in DAT reactivity, presence of multiple autoantibodies on red cells, coating of red cells by IgG3 or multiple IgG subclass, higher DAT dilution and increasing IAT reactivity. We conclude that several important but simple immunohematological parameters may influence the degree of in vivo hemolysis in WAIHA. Since a set of common haematological and biochemical test determines the severity of in vivo hemolysis therefore a comprehensive clinical and immunohematological evaluation is advisable for a correct diagnostic and therapeutic workup of WAIHA. |
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| Keywords: | Autoimmune haemolytic anemia Direct antiglobulin test Hemolysis Autoantibody Indirect antiglobulin test |
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