Haemolytic anaemia caused by anti‐Pr^a following rubella infection

Abstract

Summary. A 24‐year‐old male was admitted to Kansai Medical University Hospital, complaining of fever, skin exanthema, jaundice, brown urine and lymphadenopathy. The patient was diagnosed as having haemolytic anaemia caused by a cold agglutinin following rubella infection. The cold agglutinin of the patient reacted strongly with group OI red blood cells (RBC), Oi cord RBC, Oi adult RBC and neuraminidase‐treated RBC, and much weaker with protease (papain, ficin, bromelin)‐treated RBC; it was identified as anti‐Pra. Cold agglutinins of anti‐Pra specificity following rubella infection in adults have rarely been reported.

Life‐threatening hemolytic anemia due to an autoanti‐Pr cold agglutinin: evidence that glycophorin A antibodies may induce lipid bilayer exposure and cation permeability independent of agglutination

“…The hemolysis was not associated with activation of complement by either the classic or the alternative pathways despite the patient's serum containing complement responsive to activation by both pathways. The immunoglobulin isotypes of the anti‐Pr CAs in patients with severe or fatal hemolysis have varied: monoclonal 2,19,20 and polyclonal IgG, 21 an IgA (D. Roelcke, personal communication, 1999), and five due to IgM 3,5,8,22‐24 . Evidence for complement activation was reported in some patients, 22,23 variable in some patients, 19,21 and not reported in others 2,20,24 …”

“…Conversely the severe hemolysis may defy a rational serologic explanation if the antibodies and/or agglutination cannot be detected at body temperature 1 . For example, some anti‐Pr cause acute, severe, 2,3 and sometimes fatal hemolysis, 4,5 when in vitro test results are minimal. The Pr antigens primarily reside on the heavily sialylated 70‐peptide‐long external proteolytically labile portion of the transmembrane glycoprotein glycophorin A (GPA) 6 .…”

Transfusion support with RBCs from an Mk homozygote in a case of autoimmune hemolytic anemia following diphtheria‐pertussis‐tetanus vaccination

“…There have been several reported cases of AIHA associated with specific viral infection. A few have been associated with anti‐Pr, including varicella infection and rubella infection 13,14 . These have involved both adults and children.…”

“…A few have been associated with anti-Pr, including varicella infection and rubella infection. 13,14 These have involved both adults and children.…”

A new mechanism for immune destruction of red blood cells?

“…Among the IgM anti‐Pr were two cases associated with varicella/chicken pox 25,29 and one case associated with DPT vaccination 33 . Among the IgG anti‐Pr were two cases of rubella, 27,32 one case of varicella, 21 and one case after DPT vaccination 34 . There are other cases of these associations without HA in the literature 10,11 …”