OBSERVATIONS ON THE NATURE OF THE AUTOANTIBODIES IN A CASE OF ACQUIRED HEMOLYTIC ANEMIA

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Abstract
Acquired autohemolytic anemia is of 2 main varieties; in one the auto-antibodies in the serum are of high titer but react most intensely at refrigerator temperature and hardly at all at body temperature. It is postulated that such cold auto-antibodies are generally of heterogenetic immune origin since they are associated with specific diseases such as virus pneumonia, trypanosomiasis, etc. This accounts for the low avidity of the antibodies, so that only when they are present in high titers does autohemolysis result. In the 2d form, the auto-antibodies react with higher titers at body temperature than at refrigerator temperature, and frequently coat the cells giving rise to a positive direct antiglobulin reaction. Such warm antibodies appear to be of true auto-immune origin, and as a rule are produced only by individuals with an abnormally increased capacity to form antibodies, as in disseminated lupus erythematosus and lymphoma, or as a result of alteration of the red cell surface by viruses rendering the red cells auto-antigenic. Warm auto-antibodies can cause hemolytic anemia even when of relatively low titer. Observations in a case cited support the theory that warm auto-antibodies are directed against the Rh-Hr substance, and where there is lack of type specificity the blood factor involved appears to be one shared by all human beings and probably related to the "nucleus" of the Rh-Hr substance.