Document Detail

A persistent severe autoimmune hemolytic anemia despite apparent direct antiglobulin test negativization.
MedLine Citation:
PMID:  10553166     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVE: Not all cases of autoimmune hemolytic anemia (AIHA) are diagnosed by the direct antiglobulin test (DAT). We present and discuss a simple method of enhancing the sensitivity of the standard DAT. DESIGN AND METHODS: We report the case of a five-month-old child diagnosed with a severe IgG-mediated AIHA, characterized by quick DAT negativization despite clinical worsening. Warm AIHA with negative DAT, possibly due to a low affinity autoantibody, unresponsive to conventional therapy, was hypothesized. RESULTS: The DAT resulted strongly positive with anti-IgG serum using a 4C saline for erythrocyte washing, to reduce the dissociation of the supposed low affinity autoantibody. Very intensive cytoreductive treatment was administered twice until clinical remission was obtained. INTERPRETATION AND CONCLUSIONS: The clinical course of AIHA can be dissociated by the DAT. Since autoantibody-mediated hemolysis with negative DAT rarely occurs, once other causes of high reticulocyte count anemia have been ruled out, the DAT after ice-cold saline washing could be a useful and easy means of corroborating the diagnosis of AHIA, when traditional methods fail.
E Biagi; G Assali; F Rossi; M Jankovic; B Nicolini; A Balduzzi
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Haematologica     Volume:  84     ISSN:  0390-6078     ISO Abbreviation:  Haematologica     Publication Date:  1999 Nov 
Date Detail:
Created Date:  2000-02-07     Completed Date:  2000-02-07     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0417435     Medline TA:  Haematologica     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  1043-5     Citation Subset:  IM    
Pediatric Hematology Department, Università di Milano, Ospedale S. Gerardo, Monza, Italy.
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MeSH Terms
Anemia, Hemolytic, Autoimmune / diagnosis*
Coombs' Test / methods*
False Negative Reactions

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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