Autoimmune Hemolytic Anemia: Routine Serologic Evaluation in a General Hospital Population

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Abstract
A unified approach to the serologic evaluation of autoimmune hemolytic anemia (AIHA) using a panel of tests is described. The “hemolytic panel” includes direct antiglobulin tests followed by study of eluates, classification and identification of autoantibodies at 37 and 4 C. with untreated and pretreated papainized cells, identification of associated isoantibodies, and screening tests for paroxysmal nocturnal hemoglobinuria (PNH) and paroxysmal cold hemoglobinuria (PCH). Three hundred fifty-four patients with unexplained anemia and/or positive direct Coombs tests were studied. Eighty-eight cases of autoimmune hemolytic anemia were found: 57 warm-antibody, 25 coldantibody, and two cases each of PCH, PNH, and T-activation. Eighteen of the warm-antibody hemolytic anemias were associated with alpha-methyldopa therapy. Serologic characterization of autoantibodies was used as a guide to transfusion in 24 cases. Clinicopathologic features of the cases are reviewed.

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