Acquired Hemolytic Anemia

Abstract

Of 3 patients with acquired hemolytic anemia, the 1st was a woman with "coated" red cells but without demonstrable auto-antibodies or iso-antibodies in her serum; she nevertheless sustained severe hemolytic reactions after transfusions of blood that was compatible in "in vitro" tests and died. The 2d patient had thrombocytopenia in addition to anemia and icterus, and exhibited no immediate significant improvement after splenectomy. Hemolytic transfusion reactions were avoided by transfusing Kell-negative blood, but the purpura did not improve. Auto-agglutination occurred only when her red cells were 1st treated with proteolytic enzymes, the titer being about the same (6-10 units) at body temp. and refrigerator temp. Clinical improvement followed when transfusions were withheld and ACTH administered, but the purpura persisted. The blood count and platelet count later became normal. After 8 mos. gangrene of the toes of the left foot, developed supporting the thesis that thrombotic thrombocytopenic purpura is 1 of the manifestations of auto-antibody disease. The 3d patient had hemolytic anemia as a complication of atypical pneumonia. Potent cold auto-agglutinins in the patient''s serum (titer 1000 units for untreated cells at refrigerator temp., but scarcely any reaction at body temp.) were demonstrated. Complete recovery followed 4 transfusions of whole blood. These observations illustrate the graver significance of auto-anti-bodies which act preferentially at body temp. even though of low titer, while the patient of Case 3 shows that hemolytic anemia due to cold auto-antibodies usually has a good prognosis even though the antibodies are of high titer.