| Abstract: | A previously untransfused 20-year-old man presented with a seven day history of malaise, fatigue, jaundice, dark urine and splenomegaly. Hemolytic anemia was indicated by a hemoglobin of 8.7 mg/dl, reticulocyte count 8 per cent, Lactic dehydrogenase 389 iu/L, bilirubin 4.3 mg/dl (direct 0.1 mg/dl), and undetectable haptoglobins. Tests for nonimmunologic mediated hemolytic anemia were negative. The direct antiglobulin test (DAT) was repeatedly negative with polyspecific, anti-IgG, -IgA, -IgM and anti-C3 antisera. The patient's serum contained a weak anti-I, anti-E strongly reactive by indirect antiglobulin test (IAT) and an antibody reactive against all cells tested. The latter antibody reacted weakly by the IAT but strongly against enzyme-treated cells (Titer 160). Eluates from the patient's red blood cells only reacted with E+ red blood cells. The patient typed E negative. He was treated for warm autoimmune hemolytic anemia (AIHA) with high doses of prednisone. By the twelfth day his response allowed the medication to be tapered and by one month from the onset of treatment laboratory studies had returned to normal. The DAT remained negative, however, following recovery, anti-E could not be eluted from the red blood cells. Anti-E remained in his serum and the titer of the enzyme reactive antibody had decreased to 16. It is suggested that the anti-“E-like” antibody may represent auto anti-Hr preferentially reacting with E+ red blood cells. A unique feature in the case is the presence of a specific antibody eluted from cells that appear to lack that antigen in a DAT-negative patient with AIHA. |
