Auto-antibodies in acquired haemolytic anaemia.

It is now widely recognized that cases of haemolytic anaemia of spontaneous or endogenous origin may be divided into two broad groups: those determined by a genetical cause resulting in the production of defective red cells, and those not so determined. Among the latter group of acquired haemolytic anaemias are cases in which there is evidence for the presence of antibodies active against the patient's own red cells. That abnormal auto-antibodies might be formed in some cases was suggested by the reports of French authors in the early years of this century. Widal, Abrami, and Brule (1908a and b; 1909) drew attention to the frequency of autokiaemagglutination in cases of l'ictere hemolytique acquis, and stressed that this was a distinguishing and characteristic finding. At about the same time Chauffard and Troisier (1908) and Chauffard and Vincent (1909) described as suffering from ictere hemolysinique and hemoglobinurie hemolysinique patients whose sera were found to contain haemolysins. Although it is true that their reports are somewhat marred by the fact that no account was taken of the existence of the normal isohaemolysins, it seems very probable that the patients' sera did in fact contain abnormal iso-antibodies. The literature between the pioneer writings of the French haematologists and more recent times is described by Dameshek and Schwartz (1940) in a comprehensive review. They found a number of references to the occurrence of marked autohaemagglutination in acquired haemolytic anaemia, but very few reports of the presence of abnormal haemolysins. They themselves, however, had previously described three patients whose sera appeardd to contain abnormal haemolysins (Dameshek and Schwartz, 1938), and a few additional cases have been reported since (Farrar, Burnett, and Steigman, 1940; David and Minot, 1944; Neber and Dameshek, 1947; Dacie, 1949). The discovery by Coombs, Mourant, and Race (1945) that red cells sensitized with "incomplete" forms of iso-antibodies might be agglutinated by antiglobulin rabbit sera has provided a new tool for the investigation of cases of haemolytic anaemia. Boorman, Dodd, and Loutit (1946) and Loutit and Mollison (1946) reported that the direct Coombs (antiglobulin) test was positive in a number of cases fulfilling the diagnostic criteria of idiopathic acquired haemolytic anaemia, whilst the test was negative in a series of cases of haemolytic anaemia of varying pathogenesis, including several examples of the familial type. This work has since been confirmed.