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The influence of ionic strength, albumin and incubation time on the sensitivity of the indirect Coombs' test.

The sensitivity of the indirect Coombs' test was investigated using saline, albumin, or low ionic strength (LIS) in the incubation phase and an incubation time varying from 5 to 120 min. Titration of 41 antibodies showed that LIS always resulted in a higher or almost the same mean scores as the other solutions after the same incubation time. The maximum mean score was always higher with LIS than with saline and was reached after a shorter period of incubation, only 20--40 min even with the weakest antibodies. With LIS, a longer incubation time than 40 min resulted in a sudden decrease in mean score. The maximum mean score using saline or albumin was reached after 40--60 min incubation. The same mean score was obtained after only 15--20 min, when LIS was used. Albumin gave only slightly higher mean scores than saline.

Antibodies

Platelet indirect radioactive Coombs test. Its utilization for PLA1 grouping.

A platelet indirect radioactive Coombs test (PIRC) has been described. The technique for purification and labelling the antiglobulin has been precised. This test allowed the typing of platelets in the PLA system by using an absorbed serum from a mother of a thrombocytopenic child. Six other families of neonatal thrombocytopenias were tested. In three of them, the mothers were found PLA1 negative (PLA2, PLA2). Among a panel of 93 platelets, two (0.022) were found PLA1, negative. This PIRC test has many advantages compared to other tests such as platelet complement fixation, assay for blocking antibodies or antiglobulin consumption: it gives objective and quantitative results and is highly reproducible; anticomplementary serum may be tested.

Animals

Positive direct antiglobulin (Coombs') test caused by cephalexin administration in humans.

Of 71 patients showing a negative direct antiglobulin (Coombs') test (DAT) before administration of cephalexin (CEX) three developed a positive DAT after therapy with this drug (4 percent). No case of immunohemolytic anemia was observed. The sera of the patients with a positive DAT reacted with cephalothin-coated red cells producing high titers, with penicillin cells normal titers and with CEX cells low titers. Since the red cell eluates of these patients did not give significant reactions with red cells sensitized with CEX, cephalothin and penicillin, a nonimmunological mechanism for the development of the positive DAT in these patients has to be assumed.

Adolescent

[Neonatal jaundice due to anti-D allo-immunization with negative direct Coombs' test].

The case is reported of a newborn with jaundice due to anti-D Rh iso-immunization, with a negative Coombs' test. The finding of a positive red cell auto-agglutination test, the red cells being treated with bromelin and incubated in their own serum, suggests an immune phenomenon. Free antibody with anti-D specificity reacting with bromelin treated R.B.C.'s was found in the sera of the mother and infant.

Coombs Test

[Familial autoimmune hemolytic animia (AIHA) with negative Coombs test, lymphocytopenia and hypogammaglobulinemia].

A family with several cases of autoimmune hemolytic anemia and dysgammaglobulinemia is described. Two sibling had documented antierythrocyte antibodies, but a third had repeatedly negative Coombs tests. Diminished immunoglobulin-producing cells and a hypogammaglobulinemia were found, but no functional defect of humoral or cell-mediated immunity could be detected.

Agammaglobulinemia

Chronic myelogenous leukemia with elevated leukocyte alkaline phosphatase, positive indirect Coombs' test, neutrophilic leukocytosis and unusual cytogenetical findings.

An unusual case of chronic myelogeous leukemia (CML) is reported which was characterized by leukocytosis without a shift to the left, elevated leukocyte alkaline phosphatase, positive indirect Coombs' test, anemia and thrombocytosis, as well as the absence of hepatosplenomegaly. The diagnosis of CML was ascertained by the presence of Philadelphia chromosome with translocation of its deleted arms on the short arms on the short arms of a chromosome No. 6. The possible relationship between the chromosomal aberration and the unusual hematological and clinical features of this case is discussed.

Adult

[Determination of the blood group, Rh-D factor, and indirect Coombs' test using the amniotic fluid].

The number of Rh-D sensibilizations provided by pregnancy and delivery has decreased as the result of the preventive measures introduced to the combat this condition. The problem, however, still exists, and to cope with it, the determination of the blood group, Rh-D factor, and the Coombs' test using the amnionic fluid allows a timely preparation for the therapy of the newborn's hemolytic disease. The method of the neutralization technique employed by the authors has proved reliable.

Amniotic Fluid

[Serologic data from 537 patients with a positive direct Coombs' test (Vienna 1949 to 1979)].

In the period from 1949--1979 537 patients with positive direct Coombs-reaction were observed, their serological findings are presented and analysed regarding correlations to ABO, Rh, age and sex. Close connexions between the strength of the direct Coombs-reaction, autoantibodies in the serum and the absence of haptoglobin were found as it was expected. The sensitivity of different methods to detect autoantibodies, frequencies and specificities are discussed. Two causes of autoimmune hemolytic anemia with monospecific autoantibodies and four healthy blood donors with unexpected and inexplicable positive direct Coombs-reaction are described.

ABO Blood-Group System