Hemolytic anemia associated with multiple autoantibodies and low serum complement

Joel L. Moake, Duane R. Schultz

Research output: Contribution to journalArticle

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Abstract

A 37 year old woman with extravascular hemolytic anemia had a positive Monospot test associated with positive antiglobulin and anticomplement Coombs' tests, cold agglutinins and warm autoantibodies. IgG-kappa (κ) antibodies, which reacted with all panel red cells at 37 °C, were eluted from her circulating red cells. However, neither immunoglobulins nor C3 was detected after her serum was adsorbed with heterologous red cell stroma at 37 °C and eluted at the same temperature in glycine buffer. In contrast, IgM-κ and IgM-Iambda (λ), IgG3-κ, IgG4-λ, IgA-λ and C3 were eluted at 37 °C from heterologous red cell stroma after adsorption with her serum at 0 °C. Thus, antibodies of several types, which were present in the patient's serum, reacted optimally with red cell antigens at low temperature. Cold-reactive IgG3-κ antibodies, which were also capable of interacting with red cells at 37 °C, probably accounted for the IgG-κ antibodies eluted from the patient's circulating red cells. The patient's serum C4 titers were decreased, with low normal to moderately depressed C3 and low normal C5, indicating that the anti-red cell IgM and/or IgG3-κ antibodies probably fixed complement. A localized cold stress test resulted in a transient increase in plasma hemoglobin and a decrease in serum C3 titer. These findings, and the beneficial clinical response obtained with small doses of prednisone, suggest that both the cold-reactive antibodies and the IgG-κ on circulating red cells were pathophysiologically significant. This is the first report of a patient with multiple red cell autoantibodies in whom serum complement component titers were determined in conjunction with characterization of the anti-red cell immunoglobulins. Subclinical infectious mononucleosis may have preceded the prolonged hemolytic episode. Clinical evidence of systemic lupus erythematosus has not appeared.

Original languageEnglish
Pages (from-to)431-437
Number of pages7
JournalThe American Journal of Medicine
Volume58
Issue number3
DOIs
StatePublished - Jan 1 1975

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Hemolytic Anemia
Autoantibodies
Serum
Immunoglobulin G
Antibodies
Immunoglobulin M
Immunoglobulins
Complement Hemolytic Activity Assay
Coombs Test
Infectious Mononucleosis
Temperature
Prednisone
Exercise Test
Systemic Lupus Erythematosus
Glycine
Immunoglobulin A
Adsorption
Anti-Idiotypic Antibodies
Buffers
Hemoglobins

ASJC Scopus subject areas

  • Nursing(all)

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Hemolytic anemia associated with multiple autoantibodies and low serum complement. / Moake, Joel L.; Schultz, Duane R.

In: The American Journal of Medicine, Vol. 58, No. 3, 01.01.1975, p. 431-437.

Research output: Contribution to journalArticle

Moake, Joel L. ; Schultz, Duane R. / Hemolytic anemia associated with multiple autoantibodies and low serum complement. In: The American Journal of Medicine. 1975 ; Vol. 58, No. 3. pp. 431-437.
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