Аuthors: G. Myronenko, R. Pavliuk
Introduction. The presence of antierythrocyte antibodies is one of the key elements in the diagnosis of autoimmune hemolytic anemia (AIHA). 80 % of AIHA are secondary (symptomatic) processes and they are a manifestation of underlying diseases (neoplasms, іnfections, lymphoproliferative disorders, autoimmune disorders, viral infections, immune deficiency states, medications and toxic effects). At the same time the traditional tests for the detection of antibodies (conglutination reaction with the adding of gelatin and Coombs test with polyspecific antiglobulin reagent) do not reveal the full range of antibodies which does not allow to form а sufficient clinician idea of the autoimmune nature of the hemolytic process and determine its activity for the prediction and optimization of patient’s treatment. This is a basic element of AIHA diagnostics detection of antierythrocyte antibodies. Due to current achievements in immunohaematology it is a necessary additional examination of patients.
Purpose. The purpose of current research study was to demonstrate the diagnostic and prognostic value range of modern immunohematological tests to evaluate autoimmune hemolytic processes.
Materials and methods. During current research 67 patients with acquired hemolytic anemia with positive tests serum for erythrocyte autoantibodies and varying degrees of severity of clinical and laboratory signs of hemolytic process were examined. The hemolysis in 1/3 patients had the secondary (symptomatic) origin – as a complication of malignant diseases of the blood, pernicious anemia, systemic connective tissue diseases, infections, uncontrolled unauthorized medication, toxic effects. We used the gel test for identification of erythrocytic antibodies, classes, subclasses and determining their density on erythrocytes as well as bringing the complement system (BioRad, USA). The statistical analysis using the statistical software package StatSoft STATISTICA 10.0.1011(USA) was performed in the research.
Results and Discussion. The results of the immunohaematological study shows a serologic range of autoantibodies: warm-active agglutinins – 52,2 %, cold-active agglutinins – 25,4 %, mixed cold- and warm-active antibodies – 7,5 %, hemolysins – 14,9 %. High-density warm agglutinins IgG1/IgG3 on the surface of red blood cells were accompanied by the maximum activity of the immune destruction and caused a significant impact on the progression of anemia – in terms of hemoglobin (p < 0,05) and the number of red blood cells (p < 0,01). Wide thermal amplitude of cold agglutinins (4–32 °C) was more important for the progression of hemolysis than their high titer. The combination of warm agglutinins IgG, IgA, IgM appeared to combine with a poor prognosis for the course of hemolytic process.
Conclusions. Coombs test is only a primary link in the diagnosis of AIHA. Consequently, further serological blood testing for the detection of all variants antibodies for the purpose of future diagnosis is needed. It is necessary to determine the density of antibodies on the surface of red blood cells in the case of warm IgG-antibodies and intensity of Coombs test reaction (3+/4+) and to examine the thermal amplitude and titer in case of identification of cold agglutinins.
Keywords: аutoimmune hemolysis, agglutinins, hemolysins, the density of antibodies.