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PubMed1993

[Hemolytic-uremic syndrome in pneumococcal meningitis and infection. Importance of T-transformation].

A 4 month old girl developed a severe hemolytic uremic syndrome (HUS) following pneumococcal sepsis and meningitis. As a result of the hemolytic anemia and thrombocytopenia with associated gastrointestinal bleeding several red blood cell and thrombocyte transfusions became necessary. No plasma was transfused to the patient and all cellular blood components to be transfused were washed thoroughly in order to avoid the administration of eventually dangerous donor anti-T antibodies. Continuous peritoneal dialysis was performed for 23 days until sufficient spontaneous urine production was resumed. From the start of increased hemolysis T-transformation of the patient's red blood cells could be shown; bacterial neuraminidase was proven in the patient's serum, which could be neutralized in vitro by a commercial intravenous IgG preparation. The direct Coombs-Test was negative and no significant amounts of anti-T antibodies were detectable in the patient's serum at any stage of the disease. Our observation suggest that the T-transformation itself has caused the increased hemolysis and not an antigen-antibody (T-anti-T) reaction. In cases of HUS und proven T-transformation, intravenous IgG preparations should be tried therapeutically to inhibit the bacterial neuraminidase.

Antigen-Antibody Reactions↗
PubMed1975

Gamma heavy chain disease: rapid, sustained response to cyclophosphamide and prednisone.

A patient, CAL, with gamma heavy chain disease is presented who has had a complete remission lasting over 2 yr with combination chemotherapy consisting of pulsatile cyclophosphamide and prednisone. The patient exhibited many features of an atuoimmune process including a vasculitis, low serum complement levels, a positive antiglobulin (Coombs) test, Raynaud's phenomenon, and keratoconjunctivitis sicca. The CAL paraprotein was found to have several previously undescribed characteristics. It reacted with antisera to Fd, Fab, and Fab', suggesting that most of the Fd portion of the molecule was intace. CAL protein consists of two polypeptide chains of molecular weight 49,000 covalently linked to form a dimer of 95,000 molecular weight. The covalent linkage suggests that the hinge region of this gamma heavy chain is intact.

Bone Marrow Examination↗
PubMed2005

Coombs-positive autoimmune hemolytic anemia in Crohn's disease.

BACKGROUND: Anemia often occurs in patients with inflammatory bowel diseases. However, hemolytic anemia is a rare complication and is associated with Coombs-positive autoimmune disorders. There are several reports of autoimmune hemolytic anemia in patients with ulcerative colitis, whereas there are only four reports of this complication in patients with Crohn's disease. We report a case of a severe course Coombs-positive hemolytic anemia in a patient with Crohn's disease, which was refractory to medical treatment but resolved after subtotal colectomy. CASE REPORT: A 29-year-old patient was submitted to our clinic several times because of a severe course of inflammatory bowel disease and additionally a Coombs-positive autoimmune hemolytic anemia. Histology indicated severe Crohn's disease, but neither medical treatment with steroids, nor with methotrexate, cyclosporine or tumor necrosis factor-alpha antibody had been successful in resolving the intestinal inflammation and the hemolytic anemia. As colonoscopy revealed a pancolitis and dysplastic changes, even in the less inflamed areas of the colonic mucosa, subtotal colectomy was indicated. Half a year later we observed clinical and immunological signs of complete remission (no gastrointestinal symptoms, negative Coombs test). CONCLUSION: Autoimmune hemolytic anemia is a rare complication of inflammatory bowel disease and has been almost exclusively described in ulcerative colitis. The etiology is not yet completely understood. Presumably, the colon displays a role in the production of anti-erythrocyte antibodies. The therapy of choice in Crohn's associated hemolytic anemia is thought to be medical treatment with corticoid steroids. Some authors additionally prefer immunmodulators. However, in the case presented, colectomy (without splenectomy) was necessary to resolve refractory hemolysis and the severe course of Crohn's disease.

Adult↗
PubMedDate not supplied

A warm antibody mediated acute hemolytic anemia with reticulocytopenia in a four-month-old girl requiring immunosuppressive therapy.

We present a four-month-old girl with severe hemolytic anemia and reticulocytopenia. This case is the youngest with hemolytic anemia encountered in our hospital. Findings of autoimmune hemolytic anemia were preceded by diphtheria-pertussis-tetanus (DPT) and oral polio vaccines which were given one month before. At admission, she had heart failure, her hemoglobin (Hb) was 27 gm/L, hematocrit (Hct) 8.5 percent, reticulocyte count 0.2 percent, and gamma and non-gamma Coombs tests were positive. Plasma Hb was 23 percent (N < 3%) and haptoglobin 0 mg/dl. Bone marrow aspiration smear revealed erythroid hyperplasia. No infection, immunodeficiency or malignancy could be established. She received multiple transfusions and did not respond to methyl prednisolone therapy of seven days' duration, but was successfully treated with a combination of immunosuppressive therapy (cyclophosphamide, 6-mercaptopurine, intravenous immunoglobulin and prednisolone, which was added later). This case is interesting in that the disease was preceded by DPT vaccination, was associated with reticulocytopenia and was resistant to steroids.

Anemia, Hemolytic, Autoimmune↗
PubMed1990

[Platelet antibody activity in malaria thrombocytopenia].

To assess immune responses to malaria-induced thrombocytopenia, an haematologic and immunologic study was performed on 25 patients with imported malaria upon admission and 8 days after treatment. Thrombocytopenia (150 x 10(9)/litre) was detected in 19 cases (P. falciparum: 11 cases, P. ovale: 6 cases, P. vivax: 2 cases). No laboratory evidence of disseminated intravascular coagulation impairment was found in any of the patients. Bone marrow examination performed in 9 cases showed no abnormality in the megakaryocyte series. Platelet count was independent of circulating parasite levels (r = 0.27) and inversely related to the number of antibody binding sites (ABS) on platelets (r = -0.6, p. less than 0.01). The indirect Coombs test (r = -0.54; p less than 0.01) and IgG and IgE levels (p less than 0.02) gave similar findings. A statistical correlation was observed between the level of circulating immune complex and the number of ABS (r = 0.525, p less than 0.01). Thus malaria-induced thrombocytopenia seems to mainly involve IgG type antiplatelet antibody activity. Although they may be implicated in the binding of antibodies to platelets, circulating immune complexes do not appear to mediate thrombocytopenia.

Adolescent↗
PubMed1981

Effect of age on the induction of autoantibodies.

Three experimental models were used to compare the ease of inducing autoantibodies in young and old mice. Autoantibody to thyroglobulin (Tg) induced by immunization with cross-reactive xenogeneic Tg in Freund's complete adjuvant and autoerythrocyte antibody induced by the injection of xenogeneic erythrocytes were studied in C57Bl/6 and BALB/c male mice. In both strains, the anti-thyroglobulin antibody response to lower doses of xenogeneic Tg was significantly lower in old as compared with young animals. There were no detectable differences in incidence or strength of the direct Coombs' test following the administration of rat erythrocytes to old or young animals. In contrast, anti-mouse erythrocyte autoantibody-secreting spleen cells, generated in culture and assayed on bromelin-treated mouse erythrocytes, were more numerous in cultures of spleen cells from old as compared with young mice. These results suggest that the regulation of the autoantibody production which is stimulated by cross-reactive antigens is under different control from the spontaneous age-related increase in autoantibodies.

Aging↗
PubMed1977

[Specific immune response and immunoglobulin production in intestinal infections. III. Intestinal antibodies and immunoglobulins in the dynamics of dysentery infection].

Coproimmunoglobulins and specific coproantibodies were studied in 98 adult patients and 32 children in the course of infection caused by Sh. sonnei, and in 102 healthy individuals of various age. The concentrations of IgA, and, to a lesser extent, of the IgG and IgM proved to be significantly higher in the patients than in the healthy persons. Locally synthesized secretory IgA made up the main part of the total amount of the IgA in feces. The titres of specific coproantibodies were significantly higher in patients than in healthy persons; these antibodies, as identified by Coombs test with monospecific antiglobulin sera, mainly belonged to the secretory IgA. The local immune response to Sh. sonnei was more intensive in adults than in children. In adults the increase in the secretory IgA was revealed at the earlier stages of the disease, and specific antibodies were found more frequently and in higher titres than in children. The lesser intensity of local immune response in children apparently depends on a lesser maturity of the IgA system providing the local defence.

Adult↗
PubMed1976

ABO hemolytic disease in Puerto Rico and North Carolina.

A prospective study was carried out at the University of Puerto Rico Hospital (UPRH) and at the North Carolina Baptist Hospital (NCBH) in order to establish the incidence of ABO hemolytic disease (ABO HD) in the two populations and to determine the relationship of intestinal parasitic infection of the mother to ABO HD in the infant. The incidence of ABO HD among UPRH at risk pregnancies (type O mother with type A or B infant) was 28.3% or 1 in 3.5 as compared with 18.4% or 1 in 5.4 of NCBH at risk pregnancies (P less than .05). Indirect Coombs' tests in cord sera, representing the passive transfer from mother to fetus of antibodies directed toward antigens on the infants' erythrocytes, were positive in 58.8% of UPRH at risk infants as opposed to 40.4% of NCBH at risk infants (P less than .001). Maternal isohemagglutinin titers at term were higher in type O UPRH mothers than in type O NCBH mothers (P less than .01). A relationship between helminth parasitic infection of the mother and ABO HD in the infant was suspected but not proved.

ABO Blood-Group System↗
PubMed1975

Retroperitoneal fibrosis during treatment with methydopa.

Retroperitoneeal fibrosis (R.P.F.) and a positive direct Coombs test developed in a patient who had received 1.4 kg. of alpha-methyldopa over a period of 5 years. Immunofluorescence microscopy demonstrated deposits of IgG, IgM, and IgA on the collagen fibres of the R.P.F. Biopsy speciments of the temporal artery, the right kidney, and the R.P.F. did not show signs of general arterial disease on light, immunofluorescence, and electron microscopy. Drugs which provoke autoimmunisation and interfere with nervous transmission are known to induce deposition of collagen or R.P.F. This suggests that R.P.F. in this patient was probably caused by alpha-methydopa.

Biopsy↗
PubMed1992

Acquired chronic pure red cell aplasia successfully treated with intravenous pulse methylprednisolone therapy.

A 65-year-old male patient developed acquired chronic pure red cell aplasia (PRCA) associated with hypergammaglobulinemia and positive Coombs' test during the treatment of eosinophilic pneumonia with prednisolone (PSL). His PRCA was treated with oral PSL at a dose of 60 mg/day for 3 weeks, but anemia further progressed. Immediately after high-dose intravenous pulse methylprednisolone therapy (1 g/day for 3 days) however, reticulocyte crisis occurred and his anemia rapidly improved. He has been in complete remission under a maintenance dose of PSL for more than 2 years. This patient indicates that high-dose intravenous methylprednisolone therapy is one of the useful treatments, not only for constitutional PRCA, but also for acquired chronic PRCA.

Aged↗
PubMed1990

[Report of two operated cases with erythrocyte antibody].

Two operated cases with erythrocyte antibodies were reported. In the first case who required the second open heart operation for mitral stenosis, delayed hemolytic transfusion reaction by erythrocyte antibodies was recognized. The direct and indirect Coombs' tests were negative and the erythrocyte antibodies were not detected preoperatively. Massive blood transfusion during perioperative period precipitated secondary immunoreaction and reproduction of antibodies. An anti-c antibody and anti-E antibody were detected by the serologic studies on the 11th and 16th postoperative day. In the second case, stenotic mitral valve was replaced without homologous blood transfusion, because anti-C antibody was detected preoperatively. We believe that open heart operations without blood transfusion should be done, whenever possible, it should be kept in mind that delayed hemolytic transfusion reaction by erythrocyte antibody may occur after blood transfusion.

Coombs Test↗
PubMed1980

Evaluation of a pneumatic-tube system for delivery of blood specimens to the blood bank.

This study evaluated the suitability of delivering patient blood specimens to the blood bank by a hospital pneumatic-tube system. No significant discrepancies were found between duplicate pneumatic-tube and hand-carried specimens in ABO and Rh typing, Du and direct Coombs' testing, rouleaux formation, and antibody screening and identification. There were no significant differences in titers or scores of unexpected erythrocytic antibodies in duplicate pneumatic-tube and hand-carried specimens. No significant differences in antibody strength were detected between specimens from partially-filled and nearly full clot tubes delivered by pneumatic-tube. Our pneumatic-tube system may be safely used to transport patient blood specimens for routine type and crossmatch. Slight hemolysis in some pneumatic-tube specimens makes our pneumatic-tube system unsuitable for transporting blood specimens collected for evaluation of transfusion reactions.

Antibodies↗
PubMed1988

Immunological studies of pancytopenia in visceral leishmaniasis.

We report three cases of combined anemia, neutropenia and thrombocytopenia in patients with visceral leishmaniasis (kala-azar). Using immunofluorescence techniques and the common antiglobulin (Coombs') test, we showed membrane-associated antiplatelet, antineutrophil and antierythrocytic IgG antibodies in all three cases. Treatment with sodium stibogluconate raised the patients' platelet, neutrophil and erythrocyte count. At that time no antibodies were detected on peripheral blood cells. Immunological studies performed on these patients did not show marked abnormalities except for reduced T-helper cells and elevated OKM1-positive cells, which normalized after recovery. As bone marrow suppression was not found, it is suggested that pancytopenia resulted from rapid destruction of antibody-coated blood cells. Whether these antibodies are specific is not clear.

Adolescent↗
PubMed1994

[Flow cytometry analysis of IGG subclasses of auto- and alloantibodies in autoimmune hemolytic anemia and hemolytic disease of the newborn].

Red cell IgG antibodies capable of causing hemolytic disease of the newborn (HDN) or autoimmune hemolytic anemia (AIHA) have been analyzed concerning their IgG subclasses using flow cytometry. The results were always in agreement with those of the direct Coombs test. Anti-A and/or anti-B able to cause HDN belonged to the IgG1 subclass (4/8 cases) or to the subclasses IgG1 and IgG2 (4/8 cases). In 3 out of 4 cases of HDN caused by Rh antibodies the antibodies belonged to the subclasses IgG1 and IgG3. In patients with lymphoma but without AIHA, red cell autoantibodies were often found to be IgG1 only (n = 10), in low concentrations. In cases of acute AIHA in adults caused by IgG autoantibodies the subclass IgG3 was found in addition to IgG1 in 4/5 cases. In our opinion flow cytometry should become substantial for immunohematological diagnostics.

Adult↗
PubMed1980

The anaemia of P. falciparum malaria.

The haematological changes in a group of young Gambian children with P. falciparum malaria have been analysed. In children with acute infection anaemia was most marked during the period after treatment. Although many of these patients developed a positive direct Coombs test during this period of the illness it is not clear whether the anaemia which occurs after treatment has an immune basis. A second group of children showed quite different haematological findings. They appear to have a more chronic form of P. falciparum malaria infection, were profoundly anaemic at presentation, showed gross dyserythropoietic changes in their bone marrows, and had a full reticulocyte response and rise in haemoglobin after treatment. A third group of children were encountered whose haematological abnormalities were intermediate to those of the acute and chronic groups. These findings indicate that the patho-physiological mechanisms responsible for the anaemia of P. falciparum malaria are different at different stages of the illness.

Anemia↗
PubMed1980

[Autoimmune hemolytic anemia associated with chronic ulcerative colitis (author's transl)].

A case of autoimmune hemolytic anemia associated with chronic ulcerative colitis in a 28-year-old woman is reported. Immunological studies showed a strongly positive direct Coombs test of IgG type and a non-specific pannagglutinin antibody. This immunological pattern remained for 10 months instead of the medical treatment with corticosteroids and azathioprine. A subtotal colectomy with ileo-rectostomy was performed and the patient experienced a greater clinical improvement, though the total negativity of the immunitary alteration was not obtained. Weak immunological disturbances continued 19 months after the surgical procedure. A short review of the literature is presented and a total of 39 cases of erythorcitic autoimmunization (with or without hemolysis) published up to the present time have been found. Lastly, various etiopathogenic theories in relation to this complication are mentioned.

Adult↗
PubMed1977

Disappearance of IgG2B autoantibodies associated with recovery from anaemia.

Mice immunized with cross-reacting rat erythrocytes develop autoimmune haemolytic anaemia as indicated by haematological data and erythrocyte autoantibodies. With continued immunization the mice recover haematologically but remain Coombs' positive. Coombs' tests were performed using monospecific antisera to determine whether the recovery from anaemia was associated with a change in the class or subclass of the autoantibodies produced. In both splenectomized mice and in unsplenectomized mice the following subclass of erythrocyte autoantibodies were present: IgG1, IgG2A, IgG2B. IgA autoantibodies were not detected and IgM autoantibodies were only detected in splenectomized mice 1-3 weeks after the IgG autoantibodies had appeared. After six immunizations the frequency of IgG2B autoantibodies decreased and by the tenth immunization and thereon, IgG2B autoantibodies were not detected. It is proposed from these results that the anaemia is caused by IgG2B autoantibodies and the the sudden exacerbation in the anaemia that occurs in splenectomized mice is due to the production of IgM autoantibodies.

Anemia, Hemolytic, Autoimmune↗