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Chapter 15 Autoimmune and drug-induced immune hemolytic anemia
Terms in this set (44)
LAB Tests Associated with AIHA (4)
DAT, Elution, Adsorption, Antigen Typing
Means for determining whether immune-mediated destruction of RBCs is contributing to anemia
Positive DAT results confirms presence of what?
RBCs coated in vivo with antibodies or complement
AHG (Antihuman globulin) directed against (3)
IgG, Complement, or Polyspecific (C' and IgG)
DAT does not distinguish between...
autoantibodies and alloantibodies
Positive anti-complement DAT interpreted as presence of what antibody?
Complement-mediated RBC destruction can occur in the...
absence of antibodies
A positive DAT is recently transfused patient should raise the suspicion of a...
transfusion reaction (even if none was reported)
A positive DAT in an anemic patient who has not been recently transfused is suggestive of a(n)...
AIHA (Auto-immune hemolytic anemia)
DAT is performed on...
freshly drawn specimens
DAT - False positives can occur after _____ _____
DAT result can be negative if...
complete destruction of antibody or complement coated RBCs occurred (hemolysis)
Positive DAT interpreted in context of (3)
patient's history, symptoms, LAB data
Determines if there is in
binding of antibody or complement to patient's RBCs (DAT or autocontrol?)
Determines whether a pattern of reactivity may be due to the presence of autoantibodies binding in
(DAT or autocontrol?)
What do you do after a positive DAT?
Removing antibodies bound to RBCs
Elution helps distinguish _____ from _____
delayed hemolytic transfusion reaction from AIHA
Delayed reactions will demonstrate a pattern of...
reactivity that corresponds to the offending alloantibody
Autoantibodies usually result in _____
panreactivity (all cells tested positive)
Techniques that remove antibodies from plasma or serum specimen to aid in detecting coexisting alloantibodies
Two types of adsorption
Autoadsorption and alloadsorption
In an autoadsorption only _____ will be removed because _____ should not bind to the patient's RBCs as they lack the corresponding _____
(only) autoantibodies; alloantibodies; antigen
After an elution or adsorption what do you do next?
Identifies which antigens patient's RBCs lack
Antigen typing assists in determining _____ that the patient is potentially capable of making; It determines RBC antigen _____ that facilitates transfusion of _____(2) matched RBCs
Clinical features of AIHA (Same as anemia) (11 - 3 features; 3 things increased; 2 things decreased, feature, 2 morphology)
Fatigue, pallor, tachycardia, increased retic bilirubin and LDH, decreased hemoglobin and haptoglobin, hemolysis (in plasma or serum), schistocytes and spherocytes
Immunologically based anemia resulting in "self-destruction" of one's own RBCs and subsequent hemolysis
AHIA categorized based on (2)
temperature (warm, cold, mixed) and instigator (viral, drug, lymphoproliferative/autoimmune diseases)
Most common type of AIHA
Autoantibodies react optimally at 37C; commonly IgG
Causes of WAIHA (2)
Lymphoproliferative disorders and autoimmune conditions
WAIHA - Autoantibody directed against common self-antigen on _____ _____
WAIHA testing results associated with _____ _____ _____
warm reactive panagglutinin
IgM autoantibodies with optimal reactivity at cooler temperatures
CAS (Cold agglutinin syndrome)
CAS underlying etiologies (2)
Epistein-Barr virus and Mycoplasma pneumoniae
Simultaneously have two types of autoantibodies causing both WAIHA and CAS
Rare autoimmune hemolytic anemia; syphilis infections or acute, temporary hemolytic episode in children following viral infection; IgG autoantibody against P carbohydrate antigen
PCH (Paroxysmal cold hemoglobinuria)
Infrequent instances which hemolytic anemia is associated with negative DAT yet still responds to treatment for WAIHA
DAT negative AIHA
Common cause of Drug-induced IHA
DIIHA - DAT usually _____ and the antibody screen is usually _____
2) Eluate Ab ID
3) Plasma Ab ID (Phase of reaction)
1) Positive 2) Panreactive 3) Panreactive (AHG) 4) Positive
2) Eluate Ab ID
3) Plasma Ab ID (Phase of Reaction)
1) Positive 2) Negative 3) Panreactive (RT/IS) 4) Positive
What 2 antibodies are commonly found alloantibodies in patients who have warm autoantibodies in their serum; Which one is most common?
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