Gallagher M T, Branch D R, Mison A, Petz L D
Exp Hematol. 1983 Jan;11(1):82-9.
We have used an in vitro assay of monocyte-RBC interaction to study the correlation of in vitro monocyte activity with in vivo lysis in patients with autoimmune hemolytic anemia (AIHA). All of 16 patients with a positive direct antiglobulin test (DAT) (0.5 + to 4+) and clinical evidence of hemolysis showed elevated association (ARBC) and phagocytic (PRBC) indices. Of 6 patients studied with a positive DAT (0.5+ to 4+) without clinical evidence of hemolysis, none showed elevated PRBC while 2 showed slightly elevated ARBC. Thus, when using a PRBC index, our assay distinguished between hemolysing and non-hemolysing patients independent of the degree of red cell sensitization as determined by the DAT. In addition, we have studied 6 patients with a positive DAT following alpha-methyldopa therapy. Two of these patients were hemolysing, 4 were not. Again, our assay correlated with in vivo lysis. Finally, we have studied red cells from 11 patients with DAT-negative acquired hemolytic anemia. Seven of these patients showed elevated ARBC and PRBC indices, indicating a possible immune etiology involving extravascular lysis in some DAT-negative acquired hemolytic anemias.
我们采用了一种单核细胞与红细胞相互作用的体外检测方法，来研究自身免疫性溶血性贫血（AIHA）患者体外单核细胞活性与体内溶血之间的相关性。16例直接抗球蛋白试验（DAT）阳性（0.5 +至4 +）且有溶血临床证据的患者，其结合红细胞（ARBC）指数和吞噬红细胞（PRBC）指数均升高。6例DAT阳性（0.5 +至4 +）但无溶血临床证据的患者中，无人PRBC指数升高，2人ARBC指数略有升高。因此，使用PRBC指数时，我们的检测方法能够区分溶血患者和非溶血患者，而不受DAT所确定的红细胞致敏程度的影响。此外，我们研究了6例α-甲基多巴治疗后DAT阳性的患者。其中2例患者发生溶血，4例未发生。同样，我们的检测方法与体内溶血情况相关。最后，我们研究了11例DAT阴性的获得性溶血性贫血患者的红细胞。其中7例患者的ARBC和PRBC指数升高，表明在一些DAT阴性的获得性溶血性贫血中可能存在涉及血管外溶血的免疫病因。
