Intravascular hemolysis by IgA red cell autoantibodies

A 66-year-old male patient with severe intravascular hemolysis is presented . Laboratory investigation revealed initially a negative direct antiglobuli n test (DAT), suggesting a Coombs-negative hemolytic anemia, Additional tes ting with monospecific anti-IgA was strongly positive. IgA autoantibodies w ith anti-e specificity and nonspecific IgA autoantibodies were identified. A diagnosis of IgA-only-associated warm AIHA was made. Treatment included t ransfusion of multiple e-negative typed red cell concentrates and administr ation of high-dose prednisone. The pathophysiologic mechanism of the rare I gA-induced warm AIHA is discussed. (C) 2001 Elsevier Science B.V. All right s reserved.