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Title: [Clinical and Laboratory Characteristics of Primary Autoimmune Hemolytic Anemia Patients with Negative Results of DAT by Tube Test But Positive Results by Microcolumn Gel Assay].
Author: Wang Z, Zhou XL, Bo LJ, Xu Y, Liu HJ, Zhao YP.
Journal: Zhongguo Shi Yan Xue Ye Xue Za Zhi; 2022 Oct; 30(5):1532-1535. PubMed ID: 36208261.
Abstract:
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. 题目: DAT试管法阴性而微柱凝胶法阳性的原发自身免疫性溶血性贫血患者的临床与实验室特征. 目的: 探讨直接抗人球蛋白试验（DAT）试管法阴性而微柱凝胶法阳性的原发自身免疫性溶血性贫血（AIHA）患者的临床与实验室特征，为此类患者的诊断提供借鉴。. 方法: 回顾性分析2015年1月至2020年12月在本院就诊的原发AIHA患者59例。根据DAT试管法和微柱凝胶法结果将研究对象分为3组，比较各组的临床与实验室特征。. 结果: 将研究对象分为DAT两方法均阴性组（Ⅰ组，n=5）、DAT试管法阴性而微柱凝胶法阳性组（Ⅱ组，n=26）、DAT两方法均阳性组（Ⅲ组，n=28）。Ⅱ组与其他组别相比，年龄、性别组成均无显著差异，DAT微柱凝胶法抗IgG+抗C3d阳性比例低于Ⅲ组（P=0.015）。Ⅱ组临床表现以胸闷、憋气、乏力等贫血相关症状以及皮肤、巩膜黄染或尿色加深等溶血相关症状为主，但发生率与其他组别无显著差异。Ⅱ组的红细胞数（RBC）、血红蛋白（Hb）等贫血相关指标低于参考范围，但与Ⅰ组、Ⅲ组相比差异无统计学意义。Ⅱ组的网织红细胞（Ret）比率、间接胆红素（IBIL）、乳酸脱氢酶（LDH）、游离血红蛋白（F-Hb）等溶血相关指标高于参考范围，其中后2项显著高于Ⅰ组（P=0.031和P=0.036）。Ⅱ组的血清补体C3、C4水平均高于Ⅲ组（P=0.010和P=0.037）。. 结论: DAT试管法阴性而微柱凝胶法阳性的原发AIHA患者与两方法均阴性和均阳性患者相比，贫血程度接近，但补体系统参与溶血的机制和程度可能不同。这一结果可能对此类患者的实验室诊断与鉴别提供帮助。.

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