Positive Direct Antiglobulin Tests and Heteroimmune Hemolysis in Patients with Severe Aplastic Anemia and Pure Red Cell Anemia Treated with Antilymphocytic Globulin

Abstract

Forty-six patients with severe aplastic anemia (SAA), 1 with adult pure red cell aplasia (PRCA), 1 with congenital hypoplastic anemia (Diamond-Blackfan) and 1 with severe polymyositis were treated with intravenous antilymphocyte globulins (ALG) of different sources (2 of equine and 1 of rabbit origin). In all patients, direct and indirect antiglobulin tests (DAT and IAT) were performed, and in all patients treated with one type of equine ALG, positive DATs were found in Rh₀(D)-positive patients, while the serum of Rh₀(D)-neg-ative patients treated with the same ALG reacted in vitro with Rh₀(D)-positive erythrocytes. The antibody was eluted and shown to be of equine origin. Two patients suffered from frank heteroimmune hemolytic anemia. Since October 1984, the ALG of this particular source has not displayed any overt anti-erythrocyte activity any more. However, all clinicians treating patients with this type of immune immunosuppression should know that ALG may retain human erythrocyte (presumably anti-LW) activity

Apparent hemolysis following intravenous antithymocyte globulin treatment in a patient with marrow failure and a paroxysmal nocturnal hemoglobinuria clone

“…Bielory and colleagues 4 also describes a decrease in complement levels during ATG therapy. Marmont and associates 8 discovered anti‐LW‐like activity leading to hemolysis in two non‐PNH patients treated with the same lot of antilymphocyte globulin. LW‐specific activity was not found in the eluates made from our patient’s RBCs, and serum complement levels were not measured.…”

Use of Bibliotherapy in Children and Adolescents With Cancer

“…5 Huang et al 6 showed that bibliotherapy based on traditional Chinese culture using the WeChat platform can greatly improve the spiritual health of patients with liver cancer and has the potential to be widely applied to cancer patients to improve their well-being. Recently, we have found that the book, "Masnavi" by Maulana Jalal al-Din Rumi (1207-1273) 7 had a significant therapeutic contribution to improving symptoms of anxiety and depression in adolescents. 8 The books, "The Short Words" including short stories and "Message for the Sick" by Bediüzzaman Said Nursi (1877-1960) 9,10 can also be used in children and adolescents with cancer.…”

“…Despite purification techniques, residual RBC antibodies in ATG preparations may contribute to positive direct coombs test and incompatible crossmatches in recipients. 6 Marmont et al 7 analyzed 49 patients receiving ATG and found 2 patients to have frank hemolysis. De Nattes et al 8 also demonstrated a similar case after the administration of thymoglobulin.…”

Case report: rapid onset of severe anemia in childhood. A systematic approach to laboratory diagnosis

“…Once the etiology can be inferred, the significance (acute, self-limiting, or chronic disease) and available treatments (steroids, highdose IV-immune globulin, blood warmer for transfusions, keep patient warm, and plasma exchange) for childhood autoimmune hemolytic anemia are more readily identified. Passively-acquired incompatible red cell antibody IV immune globulin (IVIG) 30 Antilymphocyte globulin 31 ABO plasma-incompatible platelet transfusion 32 ABO-mismatched organ transplantation 33 Delayed hemolytic transfusion reaction 34 Drug-dependent hemolytic antibodies [35][36][37] Brown recluse spider bite 38 Warm autoimmune hemolytic anemia Post-infectious 9,10,14,15 Idiopathic 9,15 Associated with autoimmune and connective tissue disorders 9,15 Associated with abnormal immunologic states 39 Cold agglutinin disease Post-infectious 40 Idiopathic 41 Paroxysmal cold hemoglobinuria (PCH) [11][12][13][14]…”