직접항글로불린 검사 양성 환자들의 면역혈액학적 분석

Abstract

The direct antiglobulin test (DAT) is used in investigating autoimmune hemolytic anemia, druginduced antibodies, hemolytic diseases of newborn and alloimmune reactions to recently transfused red cells. We performed 3,033 DATs in our blood bank from 1985 to 1992. When using a polyspecific antihuman globulin reagent, the DAT was positive in 7.2% of all cases tested. In further studies using monospecific anti-IgG and anti-C3d reagents, three patterns of reactivity were founded: in 37% of cases, red cells are coated with IgG alone; in 18% of cases, the red cells are coated with both IgG and complement; and in 45% of cases only with complement. We evaluated clinical significance of DAT positive results with the 227 patients' medical records which can be available for reviewing among the positive DAT patients. The male to female ratio of DAT positive patient was 1:2 and 41% of cases were belong to the 20-30 years old age group. The most common underlying disorders were systemic lupus erythematosus (29.5%), idiopathic (10.1%), hematologic malignancy (8.8%), and liver disease (6.2%). Patients with warm reactive autoantibodies account for 60.4% of all DAT positive cases. Cold reactive autoantibodies were demonstrated in 11%, and the mixed-types were 2.6%. Drug-induced DAT positive findings were observed in 15.4% and the DAT postitve caused with transfusion associated alloantibodies were 7.5%. IgG warm-reactive autoagglutinins were more commonly detected in patients with autoimmune hemolytic anemia and drug induced hemolysis. Definite hemolysis was present in 37% of all DAT positive patients and especially in all patients with mixed type autoagglutinin. Drugs caused a positive DAT were cephalosporin, penicillin, isoniazid, and rifampicin.