AUTOIMMUNE HEMOLYTIC DISEASE: OBSERVATIONS OF SEROLOGICAL REACTIONS AND DISEASE ACTIVITY *

The serological characteristics of red cell antibodies in autoimmune hemolytic anemia reflect to some degree the properties and characteristics of red cell isoantibodies and may be divided by serological reactions into three main groups.'.' The incomplete gamma globulin autoantibodies, which do not usually react with complement globulin and are most reactive a t 37OC., are comparable to incomplete R h antibody. Cold agglutinins are macroglobulins which have optimum reaction a t 5°C. and dissociate as the temperature is raised so that agglutination is usually abolished above 31"C.".' These antibodies regularly produce complement hemolysis or cause adsorption of complement under certain conditions of temperature and pH .',fi In several characteristics cold agglutinins resemble the 19s anti-A and anti-B antibodies. A third group of autoantibodies may be separated from others in reacting with the red cells a t body temperature and binding fractions of complement globulin.' Agglutination of sensitized cells in antiglobulin serum is partially or wholly dependent on the adsorption of complement. The molecular species of this type of autoantibody has not been defined, but the relation t o reaction with antiglobulin serum and complement resembles certain isoantibodies. During the past decade in viuo observations with Cr"' tagged cells have demonstrated that the splenic circulation is most adapted for removing cells coated with incomplete red cell antibodies." I" The rate of removal of antibody coated cells was shown to be directly related to the concentration of incomplete isoantibody used in sensitization.'." There is some evidence that variations of concentration of cell bound warm incomplete autoantibody determine the activity of autoimmune hemolytic Three additional patients are reported here in which measanemia. 12. I:]

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