Wang Zhao, Zhou Xue-Li, Bo Li-Jin, Xu Yan, Liu Hui-Juan, Zhao Yu-Ping
Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China.
Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Tianjin 300020, China. E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Oct;30(5):1532-1535. doi: 10.19746/j.cnki.issn.1009-2137.2022.05.035.
To investigate the clinical features and laboratory characteristics of primary autoimmune hemolytic anemia (AIHA) patients with negative results of direct antiglobulin test (DAT) by tube test but positive results by microcolumn gel assay, in order to provide references for the diagnosis of these patients.
59 patients diagnosed with primary AIHA in our hospital from January 2015 to December 2020 were retrospectively analyzed. According to the results of tube test and microcolumn gel assay, the cases were divided into 3 groups, and the clinical and laboratory characteristics of each group were compared.
The cases were grouped as follows: Group I, cases with negative results by both methods of DAT (n=5); Group II, cases with negative results by tube test but positive results by microcolumn gel assay (n=26); Group III, cases with positive results by both methods of DAT (n=28). There was no significant difference in age and sex between Group II and other groups, whereas the positive rate of anti-IgG + anti-C3d of Group II was lower than that in Group III (P=0.015). The main clinical manifestations of Group II were chest tightness, shortness of breath, fatigue, as well as yellow skin and sclera or dark urine, but the incidence rate of these symptoms was not significantly different from other groups. Anemia related indexes in Group II such as red blood cell (RBC) count and hemoglobin (Hb) were lower than the reference intervals, but there was no significant difference compared with other groups. Hemolysis related indexes in Group II such as reticulocyte (Ret) ratio, indirect bilirubin (IBIL), lactate dehydrogenase (LDH) and free-hemoglobin (F-Hb) were higher than the reference intervals, and the latter two items were signficantly higher than those in Group I (P=0.031 and P=0.036). Serum complement C3 and C4 in Group II were higher than those in Group III (P=0.010 and P=0.037).
Anemia severity of primary AIHA patients who were negative of DAT by tube test but positive by microcolumn gel assay was similar to those with negative or positive results by both DAT methods, but the mechanism and degree of complement system involved in hemolysis might be different. Results above may be helpful for laboratory diagnosis of this kind of patients.
探讨直接抗人球蛋白试验（DAT）试管法结果阴性但微柱凝胶法结果阳性的原发性自身免疫性溶血性贫血（AIHA）患者的临床特征及实验室特点，为该类患者的诊断提供参考。
回顾性分析2015年1月至2020年12月在我院确诊为原发性AIHA的59例患者。根据DAT试管法和微柱凝胶法结果将病例分为3组，比较各组的临床及实验室特征。
分组如下：Ⅰ组，两种DAT方法结果均为阴性的病例（n = 5）；Ⅱ组，试管法结果阴性但微柱凝胶法结果阳性的病例（n = 26）；Ⅲ组，两种DAT方法结果均为阳性的病例（n = 28）。Ⅱ组与其他组在年龄和性别上无显著差异，而Ⅱ组抗IgG + 抗C3d阳性率低于Ⅲ组（P = 0.015）。Ⅱ组的主要临床表现为胸闷、气短、乏力以及皮肤和巩膜黄染或浓茶色尿，但这些症状的发生率与其他组无显著差异。Ⅱ组的贫血相关指标如红细胞（RBC）计数和血红蛋白（Hb）低于参考区间，但与其他组相比无显著差异。Ⅱ组的溶血相关指标如网织红细胞（Ret）比例、间接胆红素（IBIL）、乳酸脱氢酶（LDH）和游离血红蛋白（F - Hb）高于参考区间，后两项指标显著高于Ⅰ组（P = 0.031和P = 0.036）。Ⅱ组血清补体C3和C4高于Ⅲ组（P = 0.010和P = 0.037）。
DAT试管法阴性但微柱凝胶法阳性的原发性AIHA患者的贫血严重程度与DAT两种方法结果均阴性或阳性的患者相似，但溶血过程中补体系统参与的机制和程度可能不同。上述结果可能有助于此类患者的实验室诊断。
