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Auto-immune hemolytic anemias Volume 14, issue 6, Novembre-Décembre 2008

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Author
Service d’hématologie clinique, CHRU Clémenceau, Caen

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.