Anti-globulin test positivity indicates advanced disease in Indian CLL patients

Autoimmune Hemolytic Anemia (AIHA) occurs in 10% to 25% of Chronic Lymphocytic Leukemia (CLL) while Direct Antiglobulin Test (DAT) positivity seen in 35% of cases. The prevalence and prognostic significance of DAT positivity is not well documented especially in Indian population. The present study was undertaken to know prevalence and prognostic significance of DAT positivity in CLL in India by associating it with stage and CD 38 expression. The study included fifty-eight newly diagnosed and untreated cases of CLL staged according to Binet and Rai system. Complete hemogram, DAT and immuno-phenotyping by flow cytometry was done to diagnose CLL and to assess CD 38 expression. Student's t test and Chi square test was used to calculate difference between means. p value ≤0.05 was considered significant. Results-DAT positivity was found in 27.58% cases. A positive association was seen between DAT and advanced Rai and Binet stage (P = 0.024 and P = 0.014 respectively). A positive association was also seen between DAT and CD 38 (P = 0.008). The study concluded that DAT positivity in Indian CLL patients is high as compared to West. As DAT correlated with advanced Rai/Binet stage, as well as CD 38 positivity, it can be considered as a surrogate marker for advanced disease and used to select patients needing close follow up especially at places where molecular and flow cytometric set up for prognostication is not available.