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Severe autoimmune hemolytic anemia associated with IgM warm autoantibodies directed against determinants on or
1American Red Cross Blood Services, Southern California Region, Los Angeles 90006, USA.
Background And Objectives:
Autoimmune hemolytic anemiA (AIHA) is rarely caused by IgM warm autoantibodies, and is sometimes difficult to diagnose. We describe three patients with severe AIHA caused by IgM warm autoantibodies; in two of the three, the hemolysis was fatal.
Materials And Methods:
Conventional hematologic and serologic procedures were used.
Results:
The IgM autoantibodies in all three cases were directed against determinants on or associated with glycophorin A (Ena, Wrb, and Pr). The IgM autoantibodies and unusual serological characteristics, in that the agglutinins were detected or greatly enhanced only by the presence of albumin or a low pH, and/or the agglutinins reacted optimally at 20-30 degrees C.
Conclusions:
IgM warm autoantibodies directed at determinants on or associated with glycophorin A appear to cause severe (often fatal) hemolytic anemia.