ERYTHROCYTE AUTOANTIBODIES, AUTOIMMUNE HEMOLYSIS, AND CARCINOMA

Aims-To examine a large series of patients in whom both red cell autoa ntibodies and carcinoma are present; and to determine whether this rar e occurrence is a true association or a chance event. Methods-The labo ratory records of 160 patients (76 men, 84 women; mean age 68 years) w ith erythrocyte autoantibodies and confirmed carcinoma were examined f or site of tumour origin and clinical and immunohaematological finding s. To test whether the concomitant occurrence of autoantibodies and ca rcinoma was fortuitous, data on total population and carcinoma inciden ce were included in a chi(2) analysis. Results-The association was sig nificant (chi(2) = 97.5, p < 0.0005); erythrocyte autoantibodies and c arcinoma were found together 12-13 times more often than expected from their relative frequencies. Autoantibodies occurred with a variety of carcinomas, particularly those of breast, lung, colon, rectum, and pr ostate; this largely reflected tumour incidence. Adenocarcinoma, squam ous, anaplastic, and transitional cell types were ah represented. Warm , cold, and mixed were not associated with particular tumour sites or histology. Eighty six patients had haemolysis of varying severity, 37 had metastatic disease, and 28 died within a few months of presentatio n. Conclusions-The presence of erythrocyte autoantibodies and carcinom a in the same patient is a true association and probably reflects a fu ndamental disturbance in immune homeostasis. It tends to occur with a large tumour mass and metastatic disease, and generally indicates a po or prognosis.