Jefferies L C
Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia.
Hematol Oncol Clin North Am. 1994 Dec;8(6):1087-104.
Autoimmune hemolytic anemias include warm and cold reactive autoimmune hemolytic anemias (WAIHA and CAD), paroxysmal cold hemoglobinuria (PCH), and drug-induced hemolytic anemias. If autoimmune hemolytic anemia is suspected, the clinical history should be communicated to the transfusion service, because specific tests to confirm these diagnoses are not routinely performed. This includes evaluation of the patient's RBCs for bound IgG and complement (direct antiglobulin test) and evaluation of the patient's serum for antibodies with RBC specificity. For warm or cold autoimmune hemolytic anemia, special procedures including autoabsorption may be necessary to identify underlying RBC alloantibodies prior to transfusion. Transfused RBCs may not have normal survival in patients with RBC autoantibodies. The decision to transfuse should consider the patient's need for oxygen-carrying capacity, the risk of withholding transfusion, and the potential benefit of alternative therapy.
自身免疫性溶血性贫血包括温抗体型和冷抗体型自身免疫性溶血性贫血（温抗体型自身免疫性溶血性贫血和冷凝集素病）、阵发性冷性血红蛋白尿症（PCH）以及药物性溶血性贫血。如果怀疑为自身免疫性溶血性贫血，应将临床病史告知输血科，因为确认这些诊断的特定检测并非常规进行。这包括评估患者红细胞上结合的IgG和补体（直接抗球蛋白试验）以及评估患者血清中具有红细胞特异性的抗体。对于温抗体型或冷抗体型自身免疫性溶血性贫血，在输血前可能需要包括自身吸收在内的特殊程序来识别潜在的红细胞同种抗体。患有红细胞自身抗体的患者，输注的红细胞可能无法正常存活。输血决策应考虑患者对携氧能力的需求、延迟输血的风险以及替代疗法的潜在益处。
