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An 18-year-old Quarter Horse gelding was determined to have immune-mediated hemolytic anemia after detection of autoagglutination of RBC spherocytosis as well as a positive direct Coombs test result. A lack of response to treatment with corticosteroids necessiated the administration of cyclophosphamide and azathioprine. The anemia resolved after treatment with chemotherapeutic drugs.
The antigenicity or immunological characteristics of T-2588, newly-developed ester type cephem antibiotic, was studied employing rabbits, guinea pigs and mice. The results obtained were as follows: Antibody production against T-2588 was not observed in rabbit immunized with the emulsion of T-2588 and Freund's complete adjuvant (FCA). Hapten-specific antibody production against T-2525 was demonstrated by indirect hemagglutination test and 4 hrs. PCA of guinea pigs, employing rabbit antiserum hyperimmunized with the emulsion of T-2525 coupled to rabbit serum albumin and FCA. Hapten-specific antibody production against T-2525 was demonstrated by 48 hrs. PCA of rats, employing mice immunized with the mixture of T-2525 coupled to keyhole limpet hemocyanin and aluminium hydroxide gel. Cross antigenicity of T-2525 was observed to be relatively strong against cefotaxime and ceftizoxime, and very weak against cephalothin (CET), cefazolin, cefoperazone (CPZ), cefmenoxime, cefotiam and benzylpenicillin (PCG). Anaphylactic syndrome was not observed in guinea pigs actively sensitized with the emulsion of T-2588 or T-2525 and FCA. The ability of T-2588 and T-2525 to give a positive reaction in Coombs' test was rather weaker than that of CET, CPZ and PCG.
In a study of early abortions (less than 16-week pregnancies) no significant increase in fetomaternal haemorrhage was found in patients having either threatened or incomplete abortions. A statistically significant increase in fetal cells in the maternal circulation, however, occurred after curettage. The administration of oxytocic drugs in conjunction with curettage in cases of incomplete abortion did not increase the incidence of transplacental passage of fetal erythrocytes when compared with curettage alone. Of the 81 patients curetted following abortion four had a feto-maternal haemorrhage of more than 0.2 ml. The largest amount of fetal blood found in the maternal circulation was 0.4 to 0.5 ml. Preliminary data evaluating the indirect Coombs test and enzyme-treated red cells in Rh-negative post-abortion cases suggest that this amount of blood is not a primary immunizing dose but a "booster" to preformed antibody.
A case of a 59-year-old female suffering from immunohemolytic anemia, coombs negative, is presented. Six years after the diagnosis, this patient developed an adenocarcinoma of the gallbladder, with invasion of lymph nodes, liver and peritoneum; at this moment the coombs, test proving positive. The possible pathogenetic mechanisms are discussed, despite the rareness of this delayed association which is probably the first described in literature.
The study concerned 13 cases of angio-immunoblastic lymphadenopathy. This systemic lymphoid disorder has been identified only recently and is surely more common than has been thought. It is characterised by specific changes in the lymph nodes, which are infiltrated by plasmocytic and immunoblastic cells, associated with a marked degree of vascular neogenesis. This anatomical involvement is accompanied by numerous immunological manifestations, the most important of which are a positive Coombs test and a polyclonal hyperimmunoglobulinaemia. Despite the severe course of the disorder, its benign or malignant nature is uncertain and the therapeutic approach remains a subject of discussion.
In addition to developing immunosuppression, opportunistic infections, and malignancies, patients infected with human immunodeficiency virus (HIV) also develop many hematologic disorders. Although cytopenias including thrombocytopenia, anemia, and leukopenia, and bone marrow dysplasia are the most common hematologic complications encountered in such patients, hemostatic abnormalities that predispose patients to thromboembolism have also been recognized. Anemia in HIV patients can be multifactorial but an increased incidence of autoimmune hemolytic anemia has been manifested by the increased incidence of positive Coombs' test reported in patients with acquired immune deficiency syndrome (AIDS). Overt hemolysis is a rare complication. This review article discusses the etiology, pathophysiology, clinical features, diagnosis, treatment, and complications of autoimmune hemolytic anemia (AIHA) associated with HIV infection.
A cell wall protein from Staphylococcus aureus, Protein A, (SpA) has been shown to have the ability to bind the Fc region of most mammalian IgG molecules. This study uses this unusual property as the basis for a quantitative assay for erythrocyte (RBC) bound antibodies. Test serum is incubated in a suspension of normal RBC's. The cells are then washed and incubated with 125Iodine-labeled SpA (125I-SpA). After incubation cells are pelleted and bound radiolabeled SpA counted. This procedure has been performed using canine anti-goat RBC (DagRBC) serum and human anti-D serum (positive controls) to establish the kinetics of the SpA reaction in the above system. The results indicate that SpA binds to red blood cells as a function of membrane bound antibody. RBC's incubated with indirect Coombs positive sera bound 42.6% and 43.3% of the 125I-SpA, as compared to 19.2%, the upper limit of the 95% confidence interval (n = 9) for normal sera. Furthermore, significant binding was observed for certain indirect Coombs negative (direct Coombs positive) sera indicating that the SpA assay is more sensitive than the indirect Coombs test. The SpA system should provide the clinician with an inexpensive, sensitive, quantitative assay for the diagnosis of warm agglutinin autoimmune hemolytic anemia, as well as other autoimmune disorders involving membrane bound IgG.
A 57-year-old woman with diabetes mellitus, hypothyroidism, idiopathic thrombocytopenic purpura, myasthenia gravis, systemic lupus erythematosus, atopy, and basal cell cancer of the skin developed a severe Coombs'-positive autoimmune hemolytic anemia which was resistant to treatment with large doses of azathioprine, cytoxan, and prednisone. One year after transcervical thymectomy the hemolytic anemia disappeared and the patient has maintained a normal hemoglobin and negative Coombs' test without immunosuppressants even since. We believe this case report to be the first recorded instance of thymectomy-induced remission of autoimmune hemolytic anemia in an adult.
Two children presenting typical clinical features of the hemolytic-uremic syndrome had a positive direct Coombs test that remained positive throughout the illness. It is probable that an upper respiratory tract infection precipitated an antigen-antibody reaction that caused the autoimmune hemolytic anemia and immune-complex glomerulonephritis.
PANBIO Brucella immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) were assessed against Brucella standard agglutination tube and Coombs tests. The sensitivities of ELISA IgG and IgM were 91% and 100%, respectively, while the specificity was 100% for both. These ELISAs are simple, rapid, and reliable for the diagnosis of human brucellosis.
OBJECTIVE: To determine clinical and clinicopathologic features of a chronic intermittent severe hemolytic anemia characterized by erythrocyte osmotic fragility in Abyssinian and Somali cats. DESIGN: Case series. ANIMALS: 13 Abyssinian and 5 Somali cats. PROCEDURES: History, pedigree information, and results of routine laboratory tests, special erythrocyte studies, and histologic evaluation of splenic and hepatic specimens were analyzed. RESULTS: Age at which clinical signs of anemia were first apparent ranged from 6 months to 5 years. Ten cats had splenomegaly. Most often, the PCV was between 15 and 25%, but it was as low as 5% at some times. The anemia was characterized by macrocytosis and mild to moderate reticulocytosis, but no poikilocytosis. Hyperglobulinemia, lymphocytosis, mild hyperbilirubinemia, and high hepatic enzyme activities were common findings. Results of Coombs tests and tests for infectious diseases were negative. The erythrocytic osmotic fragility was high in affected cats (mean osmotic fragility, 0.66 to 0.78%), compared with healthy cats (0.48 to 0.58). No specific membrane protein abnormality, erythrocyte enzyme deficiency, or hemoglobinopathy was identified. Histologic evaluation of splenic and hepatic specimens revealed extramedullary hematopoiesis and hemosiderosis. Four of the 5 Somali cats were closely related. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of results of pedigree analyses, the apparent breed predilection, and the exclusion of other known causes of anemia in cats, we believe that the hemolytic anemia in these cats was likely a result of a novel hereditary erythrocyte defect. A genetic predisposition to immune-mediated destruction of erythrocytes could not be ruled out.
A 5-year-old female American Quarter Horse was determined to have immune-mediated hemolytic anemia after detection of a positive response to a direct Coombs' test. Penicillin-induced immune-mediated hemolytic anemia was confirmed via a direct antiglobulin test, using penicillin-coated RBC. The horse was clinically improved and the anemia resolved in response to supportive care and discontinuation of penicillin treatment. Penicillin should be considered a possible cause of immune-mediated hemolytic anemia in horses.
Antithymocyte globulin is commonly used as a therapy for rejection of transplanted organs. Its use can be associated with many side effects. We report a significant hemolytic anemia following therapy with horse-derived antithymocyte globulin. Several commercial Coombs' sera failed to yield a positive Coombs' test with the patient's erythrocytes; however, we were able to detect horse immunoglobulin on the patient's cells as well as on control red cells incubated with this particular preparation of antithymocyte globulin.
The non-obese diabetic mouse (NOD mouse) is widely used as a model of organ-specific autoimmunity because it develops specific autoimmune destruction of pancreatic beta cells mediated by T cells and culminating in insulin-dependent diabetes mellitus. Here, we report that the NOD mouse also develops Coombs'-positive hemolytic anemia, a B cell-mediated autoimmune disease. Aged NOD mice were found to have splenomegaly and jaundice predominantly due to raised unconjugated serum bilirubin. Their hematocrits were markedly lowered, and there was a reciprocal increase in the reticulocyte count. Red blood cells (RBC) from anemic mice showed a normal lytic response to hypotonicity. RBC from non-anemic mice had normal half lives in non-anemic, non-diabetic NOD mice by 51Cr labeling but, dramatically shortened half lives in anemic mice. Similar results were obtained with RBC from anemic mice. Hemolysis could be transferred with serum from anemic mice resulting in reticulocytosis. The antibody-mediated nature of the anemia was confirmed with the direct Coombs' test. Anemia was found only in mice aged greater than 200 days and was more common in diabetic (4/8) than non-diabetic (1/16) mice at 300 days. However, by 550 days, 14/17 non-diabetic mice were affected.
A 10-year-old female with a complete selective IgA deficiency and recurrent autoimmune disease (chronic active hepatitis, focal glomerulonephritis, hemolytic anemia and thrombopenic purpura) is presented. Both serum IgA and saliva secretory IgA were below the detection limit. The small bowel biopsy using a peroxidase-antiperoxidase technique showed absence of plasma cells secreting IgA. Circulating antibodies against mitochondria, microsomal thyroid antigen were detected as well as rheumatoid factor. Circulating immune complexes were present. A positive Coombs' test and a slightly positive reaction for cryoagglutinins were demonstrated. No alterations in cellular immunity were observed. Clinical and analytical improvement with prednisone and azathioprine was obtained.
Information about anticardiolipin antibodies in different autoimmune diseases has increased rapidly in the last few years. Clinical and laboratory associations with hematologic disturbances such as recurrent thromboses, lupus anticoagulant, autoimmune thrombocytopenia and positive Coombs' test have been reported in many studies. The present paper deals with a short review on the actual clinical significance of detection and measurement of anticardiolipin antibodies, as well as their putative role in different blood disorders.
We have studied the thrombocytopenia of lymphoproliferative disorders using a measurement of membrane-bound IgG by an antiglobulin consumption assay. Nine patients with chronic lymphocytic leukemia (CLL) and thrombocytopenia had increased membrane-bound IgG. Two patients with non-Hodgkins lymphoma and 1 patient with Hodgkins disease also had thrombocytopenia and increased membrane-bound IgG. Five of the patients with CLL had positive direct antiglobulin (Coombs) tests on red cells; of these, 3 patients had hemolytic anemia. In eight of the 9 patients with CLL, thrombocytopenia, and increased platelet-bound-IgG, the platelet count increased with the administration of prednisone or an alkylating agent, with splenectomy, or with a combination of these.
Of 137 hypertensive black Jamaicans who took methyldopa for a mean period of 36 months, a positive ANA was found in 1.5% and a positive direct Coombs' test in 0.7%. In 36 patients in whom hydralazine was included in the therapeutic regimen, a positive ANA was seen in only 6%. These results suggest that in black populations, immunologic abnormalities induced by antihypertensive drugs are less common than has been reported in white patients.