Clinical and reference lab characteristics of patients with suspected direct antiglobulin test (DAT)-negative immune hemolytic anemia. Immunohematology 2015;31(3):108-15
Date
02/02/2016Pubmed ID
26829176Scopus ID
2-s2.0-84982980337 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
Clinical evidence of warm autoimmune hemolytic anemia is present in 1 percent to 10 percent of patients whose direct antiglobulin test (DAT) is negative. The clinical underpinnings associated with DAT-negative immune hemolysis are poorly understood, and the current study aimed to further define the clinical characteristics associated with this form of anemia. A 19-question survey, requesting clinical information about each patient, was retrospectively mailed to all referring labs that had sent patient samples for an enhanced DAT evaluation from January 2011 through June 2013. An enhanced DAT evaluation involved a standard DAT and DATs performed using gel, polyethylene glycol, and 4°C low-ionic strength saline wash. We obtained detailed clinical information from 57 patients with an enhanced DAT investigation. Eighteen of these 57 patients (31.6%) were found to have a positive DAT, 11 (19.3%) of which were found to have a positive enhanced DAT (2 were positive by enhanced methods methods and negative by standard methods). The reported mean nadir hemoglobin for all 57 patients was 7.8% g/dL (range 3.2-12.7), and lactate dehydrogenase was 827.8 U/L (range 136-6917). Thirty-seven (18.1%) presented with a haptoglobin <10 mg/dL, and 21 (48.8%) reported spherocytes on peripheral smear. About half of the respondents reported using steroids as treatment for the anemia, and 4 of the 18 DAT-positive respondents (23.5%) changed their treatment plan because of the reference laboratory results. One patient died as a result of the reported hemolytic anemia (2.0%). We conclude that immune hemolysis detected by enhanced DAT methods is relatively common, and enhanced DAT methods are valuable tools in the diagnosis and management of patients with DAT-negative hemolytic anemia.
Author List
Karafin MS, Denomme GA, Schanen M, Gottschall JLMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Anemia, Hemolytic, Autoimmune
Child
Child, Preschool
Coombs Test
Female
Humans
Infant
Male
Middle Aged
Retrospective Studies
Surveys and Questionnaires
Treatment Outcome
Young Adult
