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Background: Gel card technique of cross matching is one of the latest techniques in blood centre. It has high sensitivity and gives accurate results. The aim of this study is to compare the sensitivity of gel card method with the conventional tube technique (CTT) for cross matching in blood centre. Material and Methods: In this study, we used Matrix gel card method based on indirect coombs test (ICT) for cross match and tube method including spin saline tube method with anti-human globulin (AHG) and without AHG at primary health care center for pre-transfusion cross matching on 100 blood samples. Observation and result: 100 samples were analyzed. 96 were compatible using matrix gel card method and spin saline tube with AHG. Remaining 04 showed incompatibility in both methods. In saline method without AHG, compatibility was seen in 94. Out of the 06 which were incompatible, 04 were true negative for incompatibility and 02 were false positive for incompatibility. Sensitivity and specificity of CTT without AHG was found to be 97.9% and 100% respectively. Sensitivity and specificity of matrix gel card was found to be 100%. Conclusion: Matrix gel card method is simple to perform and gives stable end point result that can be recorded and photocopied. It is more sensitive and specific than CTT. A larger cohort study is necessary to analyze the efficacy of Matrix gel card method over CTT without AHG. [ABSTRACT FROM AUTHOR]

Introduction: The D antigen variants are classified as weak, partial, and extremely weak (DEL) and can be differentiated using molecular tests. In Chile, the laboratories of local blood centers do not identify variants of the D antigen, referring them for study to the Reference Laboratory of the Public Health Institute of Chile. So, our aim was to talk about the results of the molecular analysis of variants of the D antigen in samples that had different results in the serological classification. Methods: In the D antigen classification of the Rh system, 479 samples with serological discrepant results were sent for molecular analysis. The Rh phenotype was performed withmonoclonal anti-C, anti-c, anti-E, and anti-e antisera by direct agglutination. To find the D antigen, researchers used direct agglutination with monoclonal antisera and indirect antiglobulin testing with the column (gel) agglutination method. Molecular analysis was performed with a polymerase chain reaction with sequence-specific primers (SSP-PCR) and sequencing. Results and discussion: The presence of D antigen variants was confirmed in 332 samples (69.3%), with an initial discrepancy in serological classification. In this group of discrepant samples, the frequency of weak RhD variants was 66% (219/332), that of extremely weak RhD was 28% (93/332), and that of partial RhD was 6% (20/332). The weak variants type 2 (27.4%), type 3 (8.4%), type 48 (8.4%), and type 1 (8.1%) were the next most prevalent variants after RHD*DEL43 (28%). The ccEe (R2r) phenotype was the most frequently detected (38.4%) and is present in 87% of the RHD*DEL43 samples. The E antigen is associated with the presence of this variant. Our analyses give the first description of D antigen variants in Chile. The most common variants are DEL type (RHD*DEL43) and weak (weak type 2), which are linked to the ccDEe (R2r) phenotype. These findings allow us to characterize the variants of the D antigen in Chile and, according to the obtained data, to design strategies for the management of donors, patients, and pregnant women. [ABSTRACT FROM AUTHOR]

The study was conducted to determine the frequency of autoimmune haemolytic anaemia in non-Hodgkin's lymphomas. A cross sectional study on 100 patients of Non-Hodgkin Lymphoma was conducted in Pathology department, KEMU, Lahore. The mean age among the patients was 50.14 ±17.053 years. The mean haemoglobin was 10.73g/dl ± 2.74. Out of 100, 88 patients had Coomb's Test negative and 12 patients had a positive result. Those having a positive coomb's test showed a higher retic count i.e., 5.05 ± 2.37. The average bilirubin levels in all NHL patients were 0.901 0.995 mg/dL, with a substantially higher mean of 2.15 1.19 mg/dL among patients who tested positive for Coomb's. The LDH levels of those immensely high 764.5 ± 441.Post stratification chi square testing showed no significant relationship was found between autoimmune hemolytic anemia among NHL patients. Age and gender have no significant effect. However, disease stage can be a risk factor. Therefore, it is emphasized that all patients of NHL, regardless of age and gender, must be thoroughly investigated. [ABSTRACT FROM AUTHOR]

The primary objective of this research was to evaluate the use of intravenous immunoglobulin (IVIG) in infants with hemolytic disease, to assess compliance with the American Academy of Pediatrics (AAP) guideline recommendations, and to review the data on which the guidelines were based. This retrospective study evaluated all infants in the NICU (neonatal intensive care unit) who received IVIG between January 2018 and December 2020 (n = 71). Total serum bilirubin (TSB) levels surrounding the time of IVIG administration, rate of rise of bilirubin, and direct antiglobulin test (DAT) status were evaluated to determine the appropriateness of IVIG use based on the 2004 AAP recommendations that was current at the time of the study. Fifty-nine infants received IVIG for hyperbilirubinemia. Of them, 80% had an ABO mismatch, 19% had Rh mismatch, and 71% were DAT-positive. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. One infant (1.6%) met all three AAP guideline criteria of being DAT-positive, bilirubin within 3 of exchange level, and rising bilirubin despite intensive phototherapy. Twenty-five (42%) babies were DAT positive and met one of the other two criteria. Only 12% (n = 7) had a bilirubin within 3 of exchange level. Most infants who received IVIG for hyperbilirubinemia did not meet the AAP criteria, prompting us to develop an institution-specific IVIG clinical practice guideline. The 2022 AAP guideline was published after our study was completed, but it confirmed our belief that IVIG usage should be more restricted and the criteria more explicit. [ABSTRACT FROM AUTHOR]

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Background: Tuberculosis is a bacterial infection involving multiple organs and systems. Its hematological presentation mainly includes anemia and leukocytosis. Evans syndrome is a rare autoimmune disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and neutropenia, with positive results for the direct Coombs test and platelet antibodies. The cooccurrence of tuberculosis and Evans syndrome is rarely reported.Case Presentation: A 69-year-old female presented with a fever and shortness of breath. Her chest computerized tomography scan showed extensive miliary nodules in the bilateral lung fields. She rapidly developed respiratory failure that required endotracheal intubation and mechanical ventilation. The acid-fast bacilli sputum smear results indicated a grade of 3+. Later on, blood testing revealed hemolytic anemia, a positive direct Coombs test result, and the presence of the platelet antibody IgG. This patient was diagnosed as having disseminated pulmonary tuberculosis and Evans syndrome. She successfully recovered after treatment with antituberculosis drugs and glucocorticoids.Conclusions: Tuberculosis can occur together with Evans syndrome. Affected patients should receive both antituberculosis and immunosuppressive drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Precise classification of incomplete antibody reactants (IAR) in the Coombs test is the primary means to prevent incompatible blood transfusions. Currently, an automatic and contactless method is required for accurate IAR classification to avoid human error. OBJECTIVE: We present an ensemble learning algorithm that integrates five convolutional neural networks and the least absolute shrinkage and selection operator (LASSO) regression algorithm into an IAR intensity classification model. METHODS: A dataset including 1628 IAR and corresponding labels of IAR intensity categories ((-), (1+), (2+), (3+), and (4+)) was used. We trained the ensemble model using 1302 IAR and validated its performance using 326 IAR. The optimal ensemble model was used to assist immunologists in classifying IAR. The chord diagrams based on the human-machine interaction were established. RESULTS: The ensemble model achieved 98.8%, 98.4%, 99.7%, 99.5%, and 99.4% accuracies in the (-), (1+), (2+), (3+), and (4+) categories, respectively. The results were compared with those of manual classification by immunologists (average accuracy: 99.2% vs. 75.6%). Using the model, all three immunologists achieved increased accuracy (average accuracy: +8.4%). CONCLUSIONS: The proposed algorithm can thus effectively improve the accuracy and efficiency of IAR intensity classification and facilitate the automation of haemolytic disease screening equipment. [ABSTRACT FROM AUTHOR]

The precise classification of incomplete antibody reaction intensity (IARI) in hydrogel chromatography medium high density medium solid-phase Coombs test is essential for haemolytic disease screening. However, an automatic and contactless method is required for accurate classification of IARI. Here, we present a deep ensemble learning model that integrates five different convolutional neural networks into a single model for IARI classification. A dataset, including 1628 IARI images and corresponding labels of IARI categories ((-), (1 +), (2 +), (3 +), and (4 +)), was used. We trained our model using 1302 IARIs and validated its performance using 326 IARIs. The proposed model achieved 100%, 99.4%, 99.4%, 100%, and 100% accuracies in the (−), (1 +), (2 +), (3 +), and (4 +) categories, respectively. The results were compared with those of manual classification by immunologists (average accuracy: 99.8% vs. 88.3%, p < 0.01). Following model assistance, all three immunologists achieved increased accuracy (average accuracy: + 6.1%), with the average accuracy of junior immunologists maximum increasing by 11.3%. The time required for model classification was 0.094 s·image–1, whereas that required manually was 5.528 s·image–1. The proposed model can thus substantially improve the accuracy and efficiency of IARI classification and facilitate the automation of haemolytic disease screening equipment. [ABSTRACT FROM AUTHOR]

The ideal way to screen for the presence of alloantibodies is by antibody screening panels which represent all clinically significant antigens in appropriate dosage. Most centers use pooled O-cells for antibody screening as it has antigens of non-ABO blood group systems that are prevalent in a representative population. Pooled O-cells sometimes fail to detect antibodies to less prevalent red blood cell antigens with reduced expression or show a dosage phenomenon. Despite pooling 4 to 5, O‑donor segments, sometimes, it is difficult to detect clinically significant antibodies. False-negative indirect Coombs test by pooled O-cells may delay getting a compatible unit for elective cases where type and screen policy is used. Donor units with weak antigenic expression or units showing dosage can come compatible despite being antigen positive and lead to a hemolytic reaction. We report two cases where antibody screening by pooled O-cells was negative; still, cross-match was incompatible. Antibody screening with a three-cell panel was positive. Antibody identification with 11‑cell panels confirmed the alloantibody to be anti-E. The present cases emphasize the importance of three-cell panels over pooled O-cells. [ABSTRACT FROM AUTHOR]

Background: A positive flow-cytometry T cell crossmatch (FTXM) has important prognostic implications, even when the complement-dependent cytotoxicity crossmatch is negative. Recent studies have shown that ABO incompatibility is associated with positive FTXM, but the underlying mechanism remains poorly understood. Cases: In five ABO blood type O recipients of kidneys from wives with type B, FTXM was positive but complement-dependent cytotoxicity crossmatch was negative. Application of a solid-phase technique (LABScreen) revealed no case with antibodies to donor-specific human leukocyte antigen. After removal of type B antibodies from patient sera, FTXM was negative for all five patients. In one tested case, the eluate prepared from the donor's T lymphocyte agglutinated only type B red blood cells, implying the existence of blood type B substances on donor T lymphocytes. Discussion: False-positive FTXM reflects blood type B substrates bound to T lymphocytes. Repeat FTXM after incubation with donor-type red blood cells (to adsorb anti-ABO antibodies) was negative. This phenomenon explains the discrepancy between FTXM and solid-phase bead assays. Demonstration of type B substances on donor T lymphocytes is necessary before absolute test validity is confirmed. Conclusion: False-positive FTXM may be associated with type B antibodies bound to T lymphocytes when a blood type O recipient receives tissue from a type B donor. This phenomenon explains the false-positive FTXM observed in the setting of ABO-incompatible kidney transplantation. [ABSTRACT FROM AUTHOR]

Copyright of Revista Biomedica is the property of Centro de Investigaciones Regionales Dr. Hideyo Noguchi; Facultad de Medicina, UADY and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Post-artesunate delayed haemolysis (PADH) is common after severe malaria episodes. PADH is related to the "pitting" phenomenon and the synchronous delayed clearance of once-infected erythrocytes, initially spared during treatment. However, direct antiglobulin test (DAT) positivity has been reported in several PADH cases, suggesting a contribution of immune-mediated erythrocyte clearance. The aim of the present study was to compare clinical features of cases presenting a positive or negative DAT. Methods: Articles reporting clinical data of patients diagnosed with PADH, for whom DAT had been performed, were collected from PubMed database. Data retrieved from single patients were extracted and univariate analysis was performed in order to identify features potentially related to DAT results and steroids use. Results: Twenty-two studies reporting 39 PADH cases were included: median baseline parasitaemia was 20.8% (IQR: 11.2–30) and DAT was positive in 17 cases (45.5%). Compared to DAT-negative individuals, DAT-positive patients were older (49.5 vs 31; p = 0.01), had a higher baseline parasitaemia (27% vs 17%; p = 0.03) and were more commonly treated with systemic steroids (11 vs 3 patients, p = 0.002). Depth and kinetics of delayed anaemia were not associated with DAT positivity. Conclusions: In this case series, almost half of the patients affected by PADH had a positive DAT. An obvious difference between the clinical courses of patients presenting with a positive or negative DAT was lacking. This observation suggests that DAT result may not be indicative of a pathogenic role of anti-erythrocytes antibodies in patients affected by PADH, but it may be rather a marker of immune activation. [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Saline agglutination tests (SATs) are widely recommended for diagnosis of immune‐mediated hemolytic anemia in dogs, but there are frequent false‐positive results. Objectives: Specificity of SATs will improve at higher saline‐to‐blood ratios. Animals One hundred fifty dogs treated at a veterinary referral hospital with hematocrits ≤30%. Methods: Prospective diagnostic accuracy study. Immune‐mediated hemolysis (IMH) was considered present if a gel direct antiglobulin test (DAT) was positive and there was clinical evidence of hemolysis (n = 9), absent if another mechanism for anemia was identified and the DAT was negative or there was no hemolysis (n = 138), and if IMH status was unclear, dogs were excluded (n = 3). Saline agglutination tests were prepared at 1 : 1, 4 : 1, 9 : 1, and 49 : 1 saline‐to‐blood ratios, and microscopic agglutination was considered a positive result. Results: Specificity for IMH increased from 29% (95% confidence interval 20‐38) at a 1 : 1 dilution to 97% (93‐99) at a 49 : 1 dilution. Sensitivity was 88% (47‐100) at 1 : 1 and 4 : 1 dilutions and 67% (30‐93%) at 9 : 1 and 49 : 1 dilutions. Diagnostic accuracy increased from 33% (24–42) at 1 : 1 dilution to 95% (90‐98) at 49 : 1 dilution. Conclusions and Clinical Importance: If performed using a 49 : 1 saline‐to‐blood ratio, SATs achieve high specificity for IMH. Based on a gold standard of positive DAT and evidence of hemolysis, lower saline‐to‐blood ratio results should not be used because false‐positive results are common. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Colombiana is the property of Acta Medica Colombiana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of the study is to study the positivity of Coombs test or direct antiglobulin test (DAT) in systemic lupus erythematosus (SLE) patients and its relationship with disease's clinical and serological profile. Retrospective study of 373 SLE patients seen at single Rheumatology Unit. Epidemiological data (age, gender, age at disease onset, auto declared ethnic background and tobacco use), clinical (malar rash, photosensitivity, oral ulcers, discoid lesions, serositis, glomerulonephritis, convulsions, psychosis, hemolytic anemia, leukopenia, lymphocytopenia and arthritis), and serological profile (anti ds DNA, anti Ro/SS-A; anti La/SS-B, Anti RNP, Anti Sm, aCl (anticardiolipin) IgG, aCl Ig M, LA or lupus anticoagulant, rheumatoid factor and direct Coombs) were collected. Patients with a positive DAT were compared with the negatives. DAT was positive in 12.8% of patients and 54.3% of them had hemolytic anemia. In univariate analysis, a positive DAT was associated with hemolytic anemia ( p < 0.0001), secondary antiphospholipid antibody syndrome ( p = 0.02), anticardiolipin IgG ( p < 0.0001), lupus anticoagulant ( p = 0.05), positive VDRL ( p = 0.004), anti-RNP ( p < 0.0001), anti-Sm ( p = 0.002), and anti-La ( p = 0.02). Logistic regression revealed that hemolytic anemia, anti-RNP and anti-LA were independently associated with positive DAT. DAT was positive in 12.8% of SLE studied sample and 54.3% of them had hemolytic anemia. This test was independently associated with hemolytic anemia, anti-RNP and anti-La antibodies. [ABSTRACT FROM AUTHOR]

Background and Objectives: Blood transfusion may induce some adverse effects on receivers. Some methods such as antibody screening and cross matching have been suggested to reduce the risk of transfusion complications. However, these methods require commercial antibody screening kits that may also need special equipment. The aim of this study was to introduce a new method for antibody screening that does not require a commercial kit, and could be used in any transfusion laboratory. Methods: We examined 350 samples that contained alloantibody and 350 control samples without the antibody. A solution containing two O+ and one O- samples were used instead of screening cells. Results: Sensitivity and specificity of the method were 73.32% and 45.15%, respectively. Positive predictive value and negative predictive value were 58.33% and 63.88%, respectively. Conclusion: Our new method can be used in basic hematology laboratories with some modifications. [ABSTRACT FROM AUTHOR]

Copyright of MEDISAN is the property of Centro Provincial de Informacion en Ciencias Medicas de Santiago de Cuba and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A rapid and simple paper-based elution assay for red blood cell antigen typing by the indirect antiglobulin test (IAT) was established. This allows to type blood using IgG antibodies for the important blood groups in which IgM antibodies do not exist. Red blood cells incubated with IgG anti-D were washed with saline and spotted onto the paper assay pre-treated with anti-IgG. The blood spot was eluted with an elution buffer solution in a chromatography tank. Positive samples were identified by the agglutinated and fixed red blood cells on the original spotting area, while red blood cells from negative samples completely eluted away from the spot of origin. Optimum concentrations for both anti-IgG and anti-D were identified to eliminate the washing step after the incubation phase. Based on the no-washing procedure, the critical variables were investigated to establish the optimal conditions for the paper-based assay. Two hundred ten donor blood samples were tested in optimal conditions for the paper test with anti-D and anti-Kell. Positive and negative samples were clearly distinguished. This assay opens up new applications of the IAT on paper including antibody detection and blood donor-recipient crossmatching and extends its uses into non-blood typing applications with IgG antibody-based diagnostics. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

We report the case of a 9-year-old girl who presented with mixed-type fulminant autoimmune hemolytic anemia (AIHA) at the onset of systemic lupus erythematosus (SLE). On admission, laboratory investigations indicated very severe anemia (Hb, 2.7 g/dL) with reticulocytosis and positive direct/indirect Coombs tests. In addition, agglutinative reaction was clinically observed. Based on further examinations, the patient was diagnosed with AIHA complicated with SLE, and mixed-type AIHA was clinically identified. With oral prednisolone and methylprednisolone pulse therapy, the patient entered remission. [ABSTRACT FROM AUTHOR]

Objective Hemolytic disease of the newborn (HDN) most commonly occurs in neonates whosemothers carry nonpassively acquired antibodies directed against red blood cell (RBC) antigens. Because affected neonates may develop severe hyperbilirubinemia, early identification of at-risk neonates is critically important. We hypothesized that use of the direct antibody test (DAT) would be of high predictive value in identifying those neonates most likely to meet treatment criteria for hyperbilirubinemia. Study Design We performed a retrospective chart review of all mother--infant pairs in which RBC antibodies were detected on routine prenatal screening during the current pregnancy (2011-2013). We then compared DAT results of neonates who eventually met the treatment criteria for hyperbilirubinemia with those who did not. Main Results Fifty-sixty neonates were born to mothers with clinically significant antibodies. The sensitivity and specificity of a positive DAT result for meeting the treatment criteria were 87.5 and 93.3%, respectively. The positive and negative predictive values were 77.8 and 96.6%, respectively. Conclusion The result of a DAT, obtained in neonates of mothers with clinically relevant alloantibodies, is a specific marker with good positive predictive value for identifying those who are most likely to meet the treatment criteria for hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Background: Rh D antigen is the next most important after ABO antigens in the field of transfusion medicine. Weak D refers to reduced expression of D antigen on the red blood cell that requires an extended testing with indirect antiglobulin test (IAT) to get detected. Clinical importance of weak D arises when labelling the donor and patient, as the donor is labelled as D positive, patient as D negative. Methods: In our center all blood donor and patient samples are tested for ABO and Rh D by conventional tube technique using two anti-D reagents; anti-D immunoglobulin M (IgM) monoclonal and a blend of anti-D IgM and immunoglobulin G (IgG). The blood samples which were negative for agglutination by immediate spin method were further tested for weak-D using IgG anti-D in the IAT phase with low ionic strength solution (LISS)/Coombs'gel card. Results: A total of 46,654 blood samples were tested (22,326 donors and 24,328 patients) during the period January 2012 to August 2014. Among these 43,771 (93.82%) were Rh D positive and remaining 2,883 (6.18%) were Rh-D negative. A total of 30 individuals (16 donors and 14 patients) were weak D positive constituting 1.04% of Rh-D negatives and 0.06% of total individuals screened. Conclusions: This study shows the prevalence of weak D antigen in our population who are representative of Rayalaseema region of Andhra Pradesh. It also stresses the need to identify individuals with variant D (rather than weak or partial D) and to inform them about their status as donor and recipient of blood/organ. [ABSTRACT FROM AUTHOR]

Direct antiglobulin test positivity had been reported in the course of some lymphoproliferative neoplasms. However, there are a few case reports describing direct antiglobulin test (DAT) positivity in children with acute lymphoblastic leukemia (ALL). We herein report 8 patients who had positive DAT among 95 newly diagnosed children with ALL. None of these patients had evidence of hemolysis during the follow-up. An antibody was detected in 2 of 8 patients with positive DAT. These 2 children also had positive indirect antiglobulin test (IAT); an autoantibody that was reactive at 4°C, and an alloantibody (anti E) that was reactive at 37°C was detected. We believe DAT positivity in ALL without significant hemolysis is not a rare disorder, and a need for further prospective studies is apparent. [ABSTRACT FROM PUBLISHER]

In recent years we have observed that some patients with idiopathic cytopenia of undetermined significance ( ICUS) responded well to corticosteroid and high-dose intravenous immunoglobulin treatment, indicating that some cytopenia in ICUS might be mediated by autoantibodies. In this study, we analysed 166 ICUS cases retrospectively, some of which were autoantibodies detected on haemopoietic cells in bone marrow ( BM) by BM mononuclear cell ( BMMNC)- Coombs test, flow cytometry ( FCM), Western blot and immunofluorescence ( IF). We found that 25·9% (43 of 166) of the cases had autoantibodies positive verified with BMMNC- Coombs test or FCM analysis, 72·1% (31 of 43) of whom had immunoglobulin ( Ig)G autoantibody positive by Western blot. IgG could be detected in the erythroblastic islands on the BM smear of nine (32·1%, nine of 28) ICUS patients with autoantibodies by IF. Of these 43 patients, the median percentage of reticulocytes was 1·79%. More than half the patients had hyper- BM cellularity with a higher percentage of nucleated erythroid cells in the sternum. Total response rates to immunosuppressive therapy at 6, 12, 24 and > 36 months were 46·5% (20 of 43), 75% (30 of 40), 77·4% (24 of 31) and 66·7% (16 of 24), respectively. We termed this group of ICUS cases with autoantibodies as immunorelated haemocytopenia (or BMMNC- Coombs test-positive haemocytopenia). [ABSTRACT FROM AUTHOR]

Polygenic IgG autoantibodies are implicated in majority of the cases of warm autoimmune hemolytic anemia (WAIHA). In some of these cases, complement (C3) proteins accompany the IgG antibodies. WAIHA mediated by C3 alone is relatively rare. We present an interesting case of WAIHA with a direct antiglobulin test (DAT) positive for C3 but negative for IgG in a 79-year-old woman and perform an analytical literature review of the incidence and severity of this clinical entity. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical spectrum of hemolytic disease due to irregular blood subgroup incompatibility in hospitalized neonates. Study Design: The medical records of the all hospitalized newborn patients diagnosed with indirect hyperbilirubinemia due to subgroup incompatibility in Kell, C, c, E, and e systems were included in the study. Data from 106 newborns with hemolytic jaundice due to irregular blood subgroups were retrospectively evaluated, and clinical and laboratory findings were compared between patients . The treatment modalities given to the patients of each subgroup types and the laboratory findings and treatment modalities of the cases according to Coombs tests results were also analyzed. Fetal affection of the hemolysis and also fetal losses due to irregular red-cell alloimmunization were not detected in prenatal course, as there was no follow-up of these pregnancies. Results: The mean postnatal hospitalizing age was 6.1 5.2 days after birth. The mean total bilirubin level and the mean hemoglobin value on hospitalization were 343.7 63.3 μmol/L (=20.1 3.7 mg/dL) and 14.9 3.4 g/dL, respectively. Of 106 patients identified with irregular subgroup incompatibility, 40 infants (37.7%) were associated with C, 22 (20.8%) with c, 30 (28.3%) with E, 9 (8.5%) with e, and 5 (4.7%) with Kell subgroup system. Positive Coombs tests (either direct and/or indirect) occurred in 28.3% of the study cases. Hydrops fetalis was determined in 5 of 106 neonates (4.7%). Twenty-two of 106 (20.8%) patients required total exchange transfusion. Positive Coombs test in cases required total exchange transfusion was 63.6%. Conclusion: Our data expose the magnitude and spectrum of the potential developing severe hemolytic disease and immune hydrops due to irregular subgroup incompatibility. Minor group antibody screening is recommended both in the mother and the high-risk infants with hyperbilirubinemia and hemolytic disease of the newborn. [ABSTRACT FROM AUTHOR]

A positive direct Coombs test (DCT) is the hallmark of diagnosis of immune hemolytic anemias. The reagent used for the test is the Antihuman globulin (AHG), which may be either 'Polyspecific' or 'Monospecific'. The advent of the Gel card systems has made the procedure and interpretation of DCT simpler. Aim of this study is to evaluate three of the various techniques used for the performance and interpretation of DCT. A total of 96 EDTA samples were included in the study. DCT was performed by (i) polyspecific AHG manual tube method (ii) polyspecific AHG Gel card method and (iii) monospecific AHG (Anti IgG and Anti Complement) manual tube method. In our study we considered positivity by monospecific AHG as the standard for diagnosis. Of the total 96 samples evaluated, 44 cases positive by Gel card method, were also positive for either one or both the monospecific AHG reagents. 17 cases positive by Gel card were negative by all manual methods. These false positive cases were attributed to reasons such as increased ESR, macrocytosis and marked leucocytosis. Nine cases were negative by Gel card but were positive with the Monospecific AHG. The sensitivity of DCT done by the Gel card technique was 83.01% and the specificity was 60.46%. Use of Gel card technique to perform and interpret DCT is easier than manual tube methods, but positivity by Gel card needs to be correlated with clinical presentation of the patient and other laboratory findings. Monospecific antisera can be used to confirm cases that are positive by the Gel card systems. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Microbiology & Infectious Diseases is the property of Journal of Microbiology & Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Microbiology & Infectious Diseases is the property of Journal of Microbiology & Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Brucellosis is a major health problem worldwide, especially in developing countries. Following infection with brucella, antibodies appear in the serum and its titer detection can help us to evaluate the course and epidemic status of the infection. The aim of this study was to determine the seroprevalence of anti-brucella antibody titer in rural population of Abhar. Patients and methods: In this descriptive study, 300 individuals were randomly selected for whom blood samples were screened to determine anti-brucella antibody titter, using standard tube agglutination (STA) and Coombs tests. Results: The seroprevalence of anti-brucella antibody titer was 1.25% for STA and 4.58% for Coombs test. Totally, 14 (5.83%) individuals had titers of 1/80 or higher in STA and/or Coombs tests. Conclusions: Our results emphasizes on the necessity of conducting comprehensive and scheduled program of seroprevalence survey, particularly in rural area, aimed at reducing brucella prevalence as well as to guide planning and resource allocation of decision makers for future interventions. [ABSTRACT FROM AUTHOR]

The article discusses an atypical case of acute kidney injury. Topics discussed include Hemolytic uremic syndrome (HUS) as an acute kidney injury associated with irreversible renal and central nervous system (CNS) complications, HUS caused by regulation, of defective complement alternative pathway (CAP) and investigating Coombs test and low C3 complement level as diagnostic criteria for HUS.

Robin Coombs was the last survivor of the distinguished group of immunologists that included Philip Gell, John Humphrey, John Marrack, Peter Medawar and Robert White and who were responsible for the renaissance of British Immunology after the Second World War. He is best remembered for describing the antiglobulin test that bears his name. The antiglobulin test revolutionised the diagnosis of haemolytic diseases and the compatibility testing of blood for transfusion. In all, Coombs authored over 200 scientific papers. Haemagglutination reactions became widely used in the diagnosis of a range of infectious agents. Together with Philip Gell, he devised the classification of allergic reactions; these were published in the textbook ‘Clinical Aspects of Immunology’, which he and Gell first edited in 1963 and which became the leading textbook on medical immunology. Robin Coombs was also one of the founders of the British Society for Immunology. [ABSTRACT FROM AUTHOR]

Thrombotic thrombocytopenic purpura (TTP) occurring in patients with systemic lupus erythematosus (SLE) is rare and can be difficult to diagnose because of overlapping features of the two disorders. The aim of this study is to further characterize this uncommon association in terms of presenting features, diagnostic difficulties and treatment outcome. This is the largest series from a single centre with 6 patients diagnosed over a 6-year period. Two thirds of the patients had a simultaneous diagnosis of TTP and SLE. Half of the patients had a positive Coombs test along with clear features of TTP. Five patients received plasmapheresis as initial treatment while 1 patient received plasma infusions only. Four out of 5 patients responded to plasmapheresis and only 1 patient required cytotoxic therapy. TTP in association with SLE appears to be underdiagnosed and a positive Coombs test is not against the diagnosis of TTP in this setting. Most of the patients respond well to plasmapheresis. In case of a poor response, cytotoxic drugs should be considered early. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Sjogren's syndrome (SS) is a chronic systemic autoimmune disease, characterized by lymphocytic infiltration of lacrimal and salivary glands. Although extra glandular manifestations are uncommon, they can occur with the musculoskeletal, renal, pulmonary and hematological disease. We report the case of a 35-year-old woman presented to us with persistent unexplained bicytopenia (anemia and thrombocytopenia). Antinuclear antibody and direct Coombs test were positive. Anti-Ro/SSA and anti-La/SSB antibodies were also positive in high titer. The final diagnosis of primary SS with autoimmune cytopenia was made. Cytopenias in SS are rarely reported. Our case illustrates that clinically significant cytopenias may present as an extraglandular manifestation of SS. [ABSTRACT FROM AUTHOR]

Haemolytic anaemia is a recognized complication of haematopoietic cell transplantation (HCT) and can result from alloimmune- or autoimmune-derived antibodies. Unlike alloimmune haemolytic anaemia, autoimmune haemolytic anaemia (AIHA) is poorly understood, particularly in the paediatric population where only case reports have been published. Between January 1995 and July 2001, 439 consecutive allogeneic HCT were performed in paediatric patients at the University of Minnesota, 31% (n = 136) from related donors (RD) and 69% (n = 303) from unrelated donors (URD). Nineteen cases of AIHA were identified with documented significant haemolysis and a positive direct antiglobulin test. All cases of AIHA occurred in URD transplants, yielding a cumulative incidence of AIHA post-transplant of 6% at 1 year. Patients transplanted for non-malignant disease, particularly metabolic diseases, had a higher incidence of AIHA post-HCT when compared with patients transplanted for malignancies (RR 4.2 95% CI 1.2–15.4, P = 0.01). Mortality was high in our series of 19 patients with 10 (53%) dying following the onset of AIHA, three as a direct consequence of haemolysis. Fifty per cent of deaths occurred from infection while on immunosuppressive therapy to treat haemolysis. Alternative treatment strategies were employed, with the majority of patients demonstrating disease refractory to traditional steroid therapy. [ABSTRACT FROM AUTHOR]

We report here for the first time a patient with μ heavy-chain disease (HCD), hyperimmunoglobulinemia, and a positive direct antiglobulin test (DAT, Coombs test). The heavy-chain diseases involve the proliferation of lymphoplasma cells of B cell origin and are characterized by the production of incomplete heavy chains devoid of light chains. The association of μ heavy-chain disease with either hyperglobulinemia or a positive DAT has not been reported in the literature to date. In this patient, immunofixation of serum proteins with monospecific antisera to α-, γ-, μ,- or δ-chains and to κ- and λ-chains revealed a precipitation band with antibody to IgM, but not with κ and λ light-chain antibodies, indicating μ heavy-chain disease. Hyperglobulinemia was present, which is very uncommon for HCD. A DAT of the patient's red blood cells (RBC) was found to be strongly positive for anti-IgG but negative for anti-IgM, -IgA, -C3c, and -C3d. However, when the eluate from the patient's red blood cells was investigated with nephelometry, it was found to contain antigens reactive with anti-γ as well with anti-μ-antiserum. When a DAT was performed with a randomly chosen test cell incubated with the eluate, the antibody-containing eluate was shown to react with anti-IgG as well as with anti-IgM-antiserum. In summary, the eluate from the patient's RBCs contained IgG and an immunoglobulin structure reactive with anti-IgM in an RBC agglutination assay as well as with anti-μ antiserum in a nephelometric investigation. Whether this IgM on the patient's erythrocytes is penta- or oligomeric, complete IgM, or the heavy chain cannot be concluded from these observations. [ABSTRACT FROM AUTHOR]

The existence of an association between autoimmune phenomena and lymphoproliferative neoplasms is well known. In Campinas at the University Hospital seventy-seven adult patients with non-Hodgkin's lymphoma (NHL) were studied at diagnosis. The histological subgroup NHL was performed using Kiel criteria and all patients were characterized by clinical and laboratory examinations according to the Ann Arbor staging. The results of the immunohaematological evaluation of our patients with NHL showed that: 28% presented erythrocyte autoantibodies (auto anti-I or auto-IgG without specificity) but only one developed haemolytic anaemia. There was a weak correlation between low-grade lymphoma and erythrocyte autoantibodies. [ABSTRACT FROM AUTHOR]

To assess the usefulness of cord blood tests in diagnosing ABO-haemolytic disease of the newborn (ABO-HDN), 132 term, adequate for gestational age (AGA) neonates were evaluated. The tests studied and their significant results were: quantitative elution test (greater than or equal to 1/16), direct Coombs test (positive), bilirubin concentration (greater than or equal to 4 mg/dl). In none of the 56 O+ newborn infants delivered by O+ women were the results of any test positive. Of the 76 A+ and B+ newborn infants delivered by O+ women, 17 (22%) developed ABO-HDN. When the combined result of any two tests was positive, the sensitivity, the specificity and the positive predictive accuracy for the diagnosis of ABO-HDN was higher than for any one of the isolated tests. The probability that ABO-HDN was present when the results of at least two cord blood tests were positive was 70%, and the probability that ABO-HDN was not present when less than two cord blood tests gave positive results was 93%. It is suggested that the combination of quantitative elution test, bilirubin concentration and direct Coombs test in the cord blood is useful for an early diagnosis of ABO-HDN. [ABSTRACT FROM AUTHOR]

Cold agglutinin-induced hemolytic anemia as the primary presentation in systemic lupus erythematosus (SLE) is extremely rare. Only few cases have been reported in literature so far. Here, we report a 17-year-old girl who presented with features of hemolytic anemia and later diagnosed as a case of SLE. [ABSTRACT FROM AUTHOR]

Two cases of ulcerative colitis with a positive Coombs test are reported herein. In a 30 year old woman, hemolytic anemia was well controlled by excision of a rectal stump left over from a former operation. A 53 year old woman had a positive Coombs test without clinical hemolytic anemia 10 years after undergoing a total procto-colectomy with ileo-anal anastomosis. Thus we concluded that total procto-colectomy may be preventive, as well as therapeutic, for Coombs positive hemolytic anemia associated with ulcerative colitis. [ABSTRACT FROM AUTHOR]

Background: Association of autoimmune haemolytic anaemia has been seldom reported with Kawasaki disease. Case characteristics: A 7-month-old boy, presented with prolonged fever, erythematous rash, severe pallor and hepatosplenomegaly. Observations: Positive Direct Coombs test and coronary artery aneurysm on echocardiography. He was managed with steroids along with intravenous immunoglobulins and aspirin. Outcome: Early identification of the condition helped in the management. Message: Patients of autoimmune hemolytic anemia with unusual features such as prolonged fever, skin rash, and mixed antibody response in Coombs test should be evaluated for underlying Kawasaki disease as a possible etiology. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 36-hours-old full term female neonate who was found to have mild jaundice with a transcutaneous bilirubin measurement of 15 milligrams/deciliter (mg/dl). The patient was detected to have anti-M antibodies associated as cause of diseases with different degrees of severity as intrauterine deaths or hemolytic disease of the newborn (HDN). The authors assert that anti-M's are the second most common non-Rh antibodies to cause HDN.

A 4-yr-old boy developed autoimmune hemolytic anemia after rubella infection and clinical manifestations cleared up after decrease in rubella specific IgM titer without any specific therapy. [ABSTRACT FROM AUTHOR]