Mitogen-stimulated DAT: a new method for the ... - Blood Transfusion

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W Barcellini et al.Table II - Clinical and laboratory characteristics of DAT-negative, MS-DAT positive AIHA patientsPatient N° Gender Hb Total Reticulocytes Haptoglobin LDH Steroid DAT* MS-DATg/dL bilirubin % mg/L U/L therapy IgG ng/mL(unconjugated)µmol/L1 F 13.3 8 (5) 1.4 1,200 420 yes neg 2792 F 12.4 13.7 (12) 0.8 2,290 296 yes neg 3213 F 12.3 10.3 (7) 0.7 1,830 377 no neg 4334 M 13.1 10 (9) 1.8 1,200 472 no neg 3025 M 12 10 (8) 0.9 690 303 yes neg 2566 M 15 13.7 (8) 0.2 870 291 no neg 3227 M 12 27 (22) 3.7 200 480 no neg 8138 F 10.9 28 (22) 4.4 200 420 no neg 4339 M 11.1 20 (18) 1.1 200 550 no neg 1,23010 F 5.3 20 (19) 6.9 200 232 no neg 1,66011 M 8.8 n.d. 4.3 200 520 yes neg 51612 M 10.8 40 (27) 15.9 200 470 no neg 85613 F 11.1 9 (8) 0.9 500 338 no neg 314Normal range female 11.5-15 0-17 (0-12)
MS-DAT: new method for AIHAFigure 1 - MS-DAT in the clinical follow up of AIHA. Levels of Hb ( ), Haptoglobin ( ), and MS-DAT ( ) are expressed aspercentage of the values at the beginning of the follow-up. For the first patient (left panel) these values were: Hb=5.8 g/dL,Haptoglobin=200 mg/L, MS-DAT=4,121 IgG ng/mL. For the second patient (right panel) these values were: Hb=13.6 g/dL, Haptoglobin=590 mg/L, MS-DAT=41 IgG ng/mLmean plus 3 SD of controls. MS-DAT positivity wascompared with standard DAT-tube positivity. Boththe standard DAT and MS-DAT were positive in 27AIHA at varying degree of clinical activity (data notshown). MS-DAT was positive in 6 DAT-negativepatients with a history of DAT-positive AIHA, whowere in clinical and laboratory remission at the momentof the study (Table II, patients 1-6).Finally, we studied 7 additional patients,tentatively diagnosed as DAT-negative AIHA on thebasis of the exclusion of other causes of haemolysisand of the clinical response to steroid therapy. Thesepatients showed a clear-cut positive MS-DAT (TableII, patients 7-13).MS-DAT was positive in 20 out of 69 B-CLL patients(10 in stage A, 4 in stage B, 6 stage C), correspondingto a prevalence of 28.9% (data not shown). StandardDAT tube was positive at the time of the study in 3stage C B-CLL patients, suffering from haemolyticanaemia, with a prevalence of 4.3%.momento dell'anemia manifesta (355 e 528 IgG ng/mL). Lamodesta ricaduta emolitica è stata controllata prontamentedalla terapia steroidea, che ha determinato unanormalizzazione dei livelli di emoglobina (da 10 a 13,4 g/dL)e aptoglobina (da 200 a 430 mg/L) e una diminuzione deivalori di MS-DAT (da 528 a 166 IgG ng/mL).DiscussioneI risultati descritti in questo lavoro dimostrano che MS-DAT è positivo in pazienti con anamnesi di MEA, cheerano in fase di remissione clinica e laboratoristica almomento dello studio e divenuti TAD negativi. Dato ancorpiù interessante, MS-DAT è risultato positivo in pazientinei quali è stata posta una diagnosi presuntiva di MEA,sulla base dell'esclusione di altre possibili cause di emolisie della risposta alla terapia steroidea. Per di più, MS-DATsi è dimostrato positivo in un terzo di pazienti affetti da B-LLC, con TAD negativo e senza segni clinici di emolisi,confermando precedenti risultati 19 . I valori assoluti di IgGBlood Transf 2003; 2: 127-36133
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