Grimaldi D, Limal N, Noizat-Pirenne F, Janvier D, Godeau B, Michel M
Service de médecine interne, CHU Henri-Mondor, 52, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
Rev Med Interne. 2008 Feb;29(2):135-8. doi: 10.1016/j.revmed.2007.08.009. Epub 2007 Sep 21.
Confirmation of autoimmune hemolytic anaemia usually relies on the detection of erythrocyte membrane-bound autoantibodies using a direct antiglobulin test. In the rare case of IgA autoantibodies-mediated autoimmune hemolytic anemia, the direct antiglobulin test can be negative, because routinely used polyspecific direct antiglobulin test reagents contain only anti-IgG and anticomplement antibodies.
We report the case of a 41-year-old woman presenting a severe autoimmune hemolytic anaemia caused by the presence of warm autoantibodies of IgA type that revealed a chronic hepatitis C virus infection.
A negative direct antiglobulin test does not completely rule out the diagnosis of autoimmune hemolytic anaemia especially in the rare case of IgA mediated immune hemolysis. The diagnosis strategy of autoimmune hemolytic anaemia associated with negative direct antiglobulin test and the potential links between autoimmune hemolytic anaemia and HCV are discussed.
自身免疫性溶血性贫血的确诊通常依赖于使用直接抗球蛋白试验检测红细胞膜结合自身抗体。在罕见的IgA自身抗体介导的自身免疫性溶血性贫血病例中,直接抗球蛋白试验可能为阴性,因为常规使用的多特异性直接抗球蛋白试验试剂仅包含抗IgG和抗补体抗体。
我们报告了一例41岁女性病例,该患者因存在IgA型温自身抗体而出现严重的自身免疫性溶血性贫血,该抗体揭示了慢性丙型肝炎病毒感染。
直接抗球蛋白试验阴性并不能完全排除自身免疫性溶血性贫血的诊断,尤其是在罕见的IgA介导的免疫溶血病例中。本文讨论了直接抗球蛋白试验阴性的自身免疫性溶血性贫血的诊断策略以及自身免疫性溶血性贫血与丙型肝炎病毒之间的潜在联系。