Introduction

Acquired haemolytic anaemias are usually divided into two main categories depending on the mechanism by which the premature destruction of red blood cells is produced. In the immune haemolytic anaemias, antibodies are the main agents of destruction. The non-immune-acquired haemolytic anaemias include diverse causes and mechanisms of haemolysis. In most anaemias, there is some shortening of the red cell survival, but in the haemolytic anaemias this shortening of red cell lifespan is the major cause of the anaemia and produces the classical features of haemolysis.

Antibody-mediated haemolysis is an important cause of acquired haemolytic anaemia. Antibodies may be autoantibodies produced by the patient's own immune system and directed against epitopes of his/her own red cell antigens or they may be alloantibodies. Alloantibodies may be produced by the patient and directed against antigens not present on that person's own red cells, but either introduced as foreign red cell antigens by blood transfusion or are secondarily acquired by the patient's red cells, as in drug-induced haemolysis. Alloantibodies directed against the patient's red cell antigens might also be introduced from outside the patient, most notably from the mother in haemolytic disease of the newborn. A simple classification of immune haemolytic anaemias is given in Table 10.1. Typically, the immune haemolytic anaemias are distinguished from the non-immune by detecting antibody on the surface of the red cells by the direct antiglobulin test (DAT), also known as the Coombs test. The DAT is an essential investigation required in identifying the cause in any case of acquired haemolytic anaemia.

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