Pregnancy‐associated haemolytic anaemia: A cause not to be forgotten

2021 ◽  
pp. 1753495X2110453
Author(s):  
Katherine Creeper ◽  
Dorothy Graham
Keyword(s):  
Corticosteroid Therapy ◽  
Haemolytic Anaemia ◽  
Direct Antiglobulin Test ◽  
Haemolytic Disease ◽  
Haematological Response ◽  
Antiglobulin Test ◽  
Multiparous Women ◽  
Anaemia In Pregnancy ◽  
Positive Direct ◽  
In Pregnancy

Anaemia in pregnancy is common, however, only a few cases of pregnancy-associated autoimmune haemolytic anaemia have been documented. Typically, such cases involve a positive direct antiglobulin test and have the potential to cause haemolytic disease of the fetus and newborn. Rarely, no autoantibodies are detected. We report two cases of direct antiglobulin test negative haemolytic anaemia occurring in multiparous women with no cause found. Both women had a haematological response to corticosteroid therapy and delivery.

Low haptoglobin and a positive direct antiglobulin test without haemolysis in pregnancy

2021 ◽  
pp. 1753495X2110027
Author(s):  
Adam Morton
Keyword(s):  
Renal Dysfunction ◽  
Lupus Erythematosus ◽  
Reticulocyte Count ◽  
Anticardiolipin Antibodies ◽  
Indirect Bilirubin ◽  
Antiglobulin Test ◽  
Anaemia In Pregnancy ◽  
Positive Direct ◽  
Serum Erythropoietin ◽  
In Pregnancy

Haemolysis is typically associated with low haptoglobin and elevated reticulocyte count, lactate dehydrogenase and indirect bilirubin. Positive direct antiglobulin testing is consistent with autoimmune haemolysis. A case of anaemia in pregnancy with low haptoglobin levels and positive direct antiglobulin testing in a woman with systemic lupus erythematosus is presented. The lack of response to intravenous immune globulin and absence of other markers of haemolysis prompted further investigation. In the setting of mild renal dysfunction, the woman’s serum erythropoietin was inappropriately low consistent with a failure of erythropoietin response to anaemia, and the woman’s haemoglobin improved rapidly with darbopoietin therapy. darbepoetin Health professionals need to be aware of the possibility of low haptoglobin and positive direct antiglobulin testing in the absence of haemolysis with autoimmune disease and anticardiolipin antibodies, and the possibility of anaemia due to failure of erythropoietin response with mild renal dysfunction in pregnancy.

scholarly journals Positive Direct Antiglobulin Test in COVID-19 patients: decision-making process

2021 ◽  
Author(s):  
Julien Cabo ◽  
Alice Brochier ◽  
Pascale Saussoy ◽  
Marie-Astrid van Dievoet ◽  
Lena Capirchio ◽  
...  
Keyword(s):  
Decision Making ◽  
Direct Antiglobulin Test ◽  
Decision Making Process ◽  
Antiglobulin Test ◽  
Positive Direct

scholarly journals Comparison of the direct antiglobulin test and the eluate technique for diagnosing haemolytic disease of the newborn

2015 ◽  
Vol 3 ◽  
pp. 17-22 ◽  
Author(s):  
Huub H. van Rossum ◽  
Nelly de Kraa ◽  
Melanie Thomas ◽  
Cas A.G. Holleboom ◽  
Ad Castel ◽  
...  
Keyword(s):  
Direct Antiglobulin Test ◽  
Haemolytic Disease ◽  
Antiglobulin Test

scholarly journals Serological Characterisation of Auto-antibodies in Patients with Direct Antiglobulin Test Positive Autoimmune Haemolytic Anaemia at a Tertiary Care Teaching Hospital in Tirupati, India

2021 ◽  
Author(s):  
Chinthapeta Keerthi ◽  
Rajendran Arun ◽  
Bandi Suresh Babu ◽  
Kinnera Vijaya Sreedhar Babu ◽  
Alladi Mohan ◽  
...  
Keyword(s):  
Haemolytic Anaemia ◽  
Teaching Hospital ◽  
Tertiary Care ◽  
Direct Antiglobulin Test ◽  
P Value ◽  
Igg Antibody ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Antiglobulin Test ◽  
Study Population

Introduction: Haemolysis in Autoimmune Haemolytic Anaemia (AIHA) is a result of Immunoglobulin G (IgG) or Immunoglobulin M (IgM) auto-antibodies with or without complement components binding to the Red Blood Cell (RBC) surface and initiating its destruction. Serologic evidence is provided by autocontrol or Direct Antiglobulin Test (DAT). Diagnostic work-up is essential as the management depends on the antibody type. Characteristics of the bound antibody and the target antigen determine the degree of haemolysis. Serological characterisation in AIHA helps to differentiate into its various types which help the clinician to decide on the treatment to be given. Aim: To serologically characterise the auto-antibodies in patients with DAT positive AIHA at a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was carried out in the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2019 to February 2020. A 40 consecutive patient samples were included in the study. Characterisation of antibody was done using polyspecific Anti-Human Globulin (AHG) reagent followed by mono-specific AHG reagent by gel method. If antibody was of IgG type, then the subclass was determined by a mono specific anti-IgG1 and anti-IgG3 gel card. Association between antibody types, subtype, and strength of DAT with severity of haemolysis were compared using Chi-square/Fisher’s-exact test. A p-value of less than 0.05 was considered statistically significant. Results: The total study population was 40 patients. The mean age of the study population was 45 years (range 13-78). Out of 40 patients, males were 30 (75%) and females were 10 (25%). The primary and secondary causes for AIHA include 4 (10%) and 36 (90%) respectively. Among 40 patients, 22 (55%) patients had IgG antibody alone, 17 (42.5%) patients had IgG antibody with combination of other antibodies and 1 (2.5%) had only complement (C3d). IgG1 was identified in 7 (18%) of patients, combination of IgG1 and IgG3 in 3 (7.7%). There was a significant association with IgG+combination (p-value=0.03), IgG1+IgG3 (p-value=0.029) and strength of reaction (p-value=0.003) with respect to severity of haemolysis. Conclusion: Presence of multiple antibodies, presence of IgG1 and IgG3 and with complement combination and presence of higher grading of reaction in gel column were associated with severity of haemolysis. We recommend that serological characterisation of auto-antibody in AIHA would help the clinician in assessing the severity of haemolysis so that management can be done appropriately.

scholarly journals Positive direct antiglobulin test in post-artesunate delayed haemolysis: more than a coincidence?

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Daniel Camprubí ◽  
Arturo Pereira ◽  
Natalia Rodriguez-Valero ◽  
Alex Almuedo ◽  
Rosauro Varo ◽  
...  
Keyword(s):  
Direct Antiglobulin Test ◽  
Antiglobulin Test ◽  
Delayed Haemolysis ◽  
Positive Direct

scholarly journals A-B Hemolytic Disease of the Newborn

Blood ◽  
1955 ◽  
Vol 10 (1) ◽  
pp. 17-28 ◽  
Author(s):  
RICHARD E. ROSENFIELD ◽  
FLORENCE EISINGER
Keyword(s):  
Reticulocyte Count ◽  
Umbilical Vein ◽  
Osmotic Fragility ◽  
Blood Groups ◽  
Direct Antiglobulin Test ◽  
Hemolytic Disease ◽  
Antiglobulin Test ◽  
Plasma Bilirubin ◽  
The Mean ◽  
Positive Direct

Abstract A study was made of oxalated umbilical vein blood of nearly every infant born at The Mount Sinai Hospital in a nine month period. A specimen of maternal blood was available for intragroup antibody screening and six cases of Rh-Hr hemolytic disease were eliminated from the data. The umbilical vein blood was tested, where possible, for: (1) group and Rh, (2) direct antiglobulin test, (3) hemoglobin, (4) reticulocyte count and examination of red cell morphology, (5) plasma bilirubin, and (6) osmotic fragility in 0.52 per cent NaCl. From the mothers’ blood groups, the infants were classified into group compatible and group incompatible, and the arithmetic means of the hemoglobin, reticulocyte count, and plasma bilirubin obtained for each class. A third class of infants, those with positive direct antiglobulin test, were analysed separately for comparison. 1. A weakly positive direct antiglobulin test was obtained on the umbilical vein blood of over 11 per cent of group incompatible infants but in none of the group compatible infants. 2. It appears that the weakly positive direct antiglobulin test detects an abnormal class of group incompatible infants, since their mean hemoglobin is low, their mean reticulocyte count is high, and their mean bilirubin is high, when these means are compared with those of the other group incompatible infants. 3. Thirty-eight of thirty-nine mothers of incompatible infants with positive direct antiglobulin test were group O. In comparison with the distribution of the blood groups of the mothers of other incompatible infants, this disproportion is of significance. 4. The mean reticulocyte count of incompatible infants with negative direct antiglobulin test is slightly (but with statistical significance) higher than the mean reticulocyte count of compatible infants. This difference was found to be associated almost entirely with group O mothers. 5. Thirty-one out of thirty-eight infants with positive direct antiglobulin test had increased osmotic fragility in hypotonic NaCl. Two of the negative cases appeared to have slight spherocytosis on blood smear.

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