A high‐titer, high‐thermal‐amplitude autoanti‐B associated with acrocyanosis but no obvious hemolytic anemia

Abstract

A patient with a powerful ABO autoantibody is described. This patient had acrocyanosis but did not appear to have an obvious hemolytic anemia. This case is a good example of the lack of correlation between in vitro serologic tests and in vivo reactions in individual patients.

Lethal autoimmune hemagglutination due to an immunoglobulin A autoagglutinin with Band 3 specificity

“…It is unclear why a powerful warm autoagglutinin did not cause obvious hemolytic anemia. Similar cases of cold agglutinins of high‐thermal range without hemolysis have been reported and remain unexplained . Autoantibodies of IgM class may cause in vivo RBC agglutination.…”

The Clinical Pictures of Autoimmune Hemolytic Anemia

“…In another example, a patient presented with acrocyanosis and a high-titer, high-thermal-amplitude, complement-fixing IgM cold agglutinin, without evidence for hemolysis. [ 51 ] In atypical cases, serologic examination for mixed warm and cold autoantibodies [ 5 ], warm IgM autoantibodies [ 52 ], or IgA autoantibodies [ 53 ] may prove useful since many of these patients exhibit more aggressive disease. Discussion between the clinician and the blood bank physician is helpful to solve difficult cases and has the potential to affect therapy.…”

“…Relapses and remissions characterize the unpredictable clinical course of idiopathic warm antibody AIHA. An older study reports survival of 73% at 10 years [ 51 ] but it is likely higher nowadays. Thromboembolic episodes are relatively common during active phases of the disease, frequently associated with anti-phospholipid antibodies [ 55 , 56 , 57 ].…”

ABO, H, and Lewis Systems

“…In one English blood centre, only six of 4668 patients with autoantibodies studied over 32 years had autoantibodies with ABO specifi city [574] . One autoanti -B was associated with acrocyanosis, but no AIHA [576] . Several examples of autoanti -A and -B have caused AIHA [574] , one resulting in fatal haemolysis and kidney failure [575] .…”