Open AccessDefining the clinical relevance of red blood cell autoantibodies by Monocyte Monolayer Assay
Author(s) -
Conrado Marina C. A. V.,
D'Avila Amanda N.,
Vieira Juliana B.,
Bonifacio Silvia L.,
Gomes Francisco C. A.,
Dezan Marcia R.,
Oliveira Valeria B.,
Ribeiro Ingrid H.,
Tucunduva Luciana T. C. M.,
MendroneJúnior Alfredo,
Rocha Vanderson,
Dinardo Carla L.
Publication year - 2018
Publication title -
journal of clinical laboratory analysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.536
H-Index - 50
eISSN - 1098-2825
pISSN - 0887-8013
DOI - 10.1002/jcla.22274
Subject(s) - hemolysis , autoantibody , medicine , immunology , hemolytic anemia , rituximab , autoimmune hemolytic anemia , red blood cell , red cell , monocyte , immune system , antibody , clinical significance , coombs test , anemia , fetus , pregnancy , biology , genetics
Background The Monocyte Monolayer Assay ( MMA ) is an in vitro simulation of red blood cell ( RBC ) alloantibody behavior. It has been classically applied to predict the risks of post‐transfusion hemolytic reactions when transfusing incompatible RBC units. Quantifying erythrophagocytosis by MMA may be an interesting option for situations where there is doubt whether a RBC autoantibody is mediating significant hemolysis. Here, we present three situations involving RBC autoantibodies in which the MMA was decisive for clarifying the diagnosis and choosing the best clinical treatment. Case Report Case 1 . Pregnant patient with severely anemic fetus exhibited warm autoantibody without signs of hemolysis. MMA revealed 30% of monocyte index ( MI ) highlighting that fetal hemolysis was caused by maternal autoantibody. Prednisone was prescribed with fetal clinical improvement. Cases 2 and 3 . Two patients with the diagnosis of mixed auto‐immune hemolytic anemia and poor response to corticosteroids were evaluated using MMA . The resulting MI was less than 10% in both cases, suggesting that the cold‐agglutinin rather than the warm auto‐IgG was responsible for overt hemolysis. Treatment with rituximab was begun, with good clinical response. Conclusion MMA can be used to evaluate the ability of RBC autoantibodies to mediate overt hemolysis. It can be especially useful to determine the role played by cold and warm auto‐antibodies in mixed auto‐immune hemolytic disease, helping to define the best treatment option.