Hématologie
MENUAuto-immune hemolytic anemias Volume 14, issue 6, Novembre-Décembre 2008
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- Key words: auto-immune hemolytic anemia, hemolysis, direct Coombs test, cold agglutinins, paroxysmal cold hemoglobinuria
- DOI : 10.1684/hma.2008.0291
- Page(s) : 432-41
- Published in: 2008
Auto-immune hemolytic anemias are, among auto-immune diseases, those where the role of autoantibodies is best defined, as they are directly pathogenic. Their fixation on the red cell surface antigen, and/or the complement activation are routinely detected by the direct Coombs test, a key element for the diagnosis of either extra or intravascular hemolytic anemia. Results of this test usually allow a clear distinction between auto-immune hemolysis of warm and cold type, which differ not only according to the optimal thermic range of antibody pathogenicity and the mode of clearance of the antibody-red cell complex, but also their treatment and causes. Recent progress highlight the mechanism leading to the tolerance rupture against red cell auto antigens, which results mainly from a control defect of autoreactive T lymphocytes, and the role of macrophage Fc receptors in the phagocytic process of red cell-autoantibidies complexes.