Autoimmune hemolytic anemia (AIHA) is characterized by the production of Coombs' antibodies, which are responsible for the destruction of RBCs. The antibody specificity of warm AIHA (WAIHA) is very complex while all cells tested are usually reactive in routine test. Although some autoantibodies have broad specificity to the Rh system, apparent specificity for simple Rh antigen (D, C, E, c, e) is rare. A 63 year-old farmer was admitted at Inha University Hospital for evaluation of anemia. He had no history of blood transfusion. He presented overt anemia with decreased Hb (6.6g/dL) and increased reticulocyte count (18.5%, corrected reticulocyte count 8.4%). The direct antiglobulin test (DAT) was strongly positive for IgG and negative for C3d while indirect antiglobulin test (IAT) was weakly positive. Both two different antibody identification test kits identified this antibody as anti-e. His Rh phenotype was CDe. Although the eluted antibody from his own RBCs failed to show specificity against e but agglutinated all the reagent RBCs, we diagnosed this case as WAIHA induced by IgG anti-Rh(e) because his serum agglutinated all e-positive RBCs while it was non-reactive with e-negative RBC in the cross-matching test. Drugs (loxoprofen, cimetidine) couldn't be ruled out as causative agent.
Anemia ; Anemia, Hemolytic, Autoimmune* ; Antibodies ; Antibody Specificity ; Autoantibodies ; Blood Transfusion ; Coombs Test ; Humans ; Immunoglobulin G ; Middle Aged ; Phenotype ; Reticulocyte Count ; Sensitivity and Specificity

Autoimmune hemolytic anemia(AIHA) is characterized by the production of Coombs antibodies, which are responsible for the destruction of RBCs. The antibody specificity of warm A1HA(WAIHA) is very complex while all cells tested are usually reactive in routine test. Although some autoantibodies have broad specificity to the Rh system, apparent specificity for simple Rh antigen(D, C, E, c, e) is rare. A 63 year-old farmer was admitted at Inha University Hospital for evaluation of anemia. He had no history of blood transfusion. He presented overt anemia with decreased Hb (6.6g/dL) and increased reticulocyte count(18.5%, corrected reticulocyte count 8.4%). The direct antiglobulin test(DAT) was strongly positive for IgG and negative for C3d while indirect antiglobulin test(IAT) was weakly positive. Both two different antibody identification test kits identified this antibody as anti-e. His Rh phenotype was CDe. Although the eluted antibody from his own RBCs failed to show specificity against e but agglutinated all the reagent RBCs, we diagnosed this case as WAIHA induced by IgG anti-Rh(e) because his serum agglutinated all e-positive RBCs while it was non-reactive with e-negative RBC in the cross- matching test. Drugs(loxoprofen, cimetidine) couldn' t be ruled out as causative agent. (Korean J Blood Transfusion 10(1): 61-67, 1999)
Anemia ; Anemia, Hemolytic, Autoimmune* ; Antibodies ; Antibody Specificity ; Autoantibodies ; Blood Transfusion ; Humans ; Immunoglobulin G ; Middle Aged ; Phenotype ; Reticulocyte Count ; Reticulocytes ; Sensitivity and Specificity