Autoerythrocyte Sensitization or Psychogenic Purpura?

The above quotation is taken from the original clinical report in which Gardner and Diamond (1955) described the syndrome of autoerythrocyte sensitization as an unusual purpuric syndrome in which crops of apparently spontaneous painful inflammatory ecchymoses occurred in four women who had sustained physical injury shortly before the onset of symptoms. They postulated that, as a result, their patients had become sensitized to their own erythrocytes and, subsequently, extravasation of blood during the unrecognized trivial injuries of everyday life induced the purpuric lesions. As predicted by this hypothesis, Gardner and Diamond could reproduce the typical bruises of autoerythrocyte sensitization by the intracutaneous injection of the patient's own blood. The offending agent appeared to be erythrocytic stroma; neither plasma, white cells nor hemoglobin elicited a response. One patient was found to be sensitive to the phosphatidyl serine of the red cell membrane (Groch, 1966). Since that time approximately 50 patients have been reported, most of whom were reviewed by Ratnoff and Agle ( 1968) ; Hers le and l\1obacken (1969). Gardner and Diamond ( 1955) postulated that fixed tissue antibody reacts with the red cell stroma to produce edema, increased capillary permeability, and extravasation of red cells into tissues. As further patients with this syndrome were reported it became clear that in some otherwise typical cases the cutaneous response to blood might be consistently negative. Further doubt that the syndrome may have anything to do with autoimmunity is raised