Blood, 1953, Vol. 8, No. 9, pp. 813-823.
© 1953 American Society of Hematology, Inc.
Acquired Hemolytic Anemia
With Special Reference to the Antiglobulin (Coombs') Reaction
J. V. DACIE M.D., M.R.C.P. (LONDON)1
1 Department of Pathology, Postgraduate Medical School of London, Ducane
Road, London, W.12, England.
Eighteen patients with acquired hemolytic anemia were studied with particular reference to the direct and indirect antiglobulin (Coombs) reaction. The
abnormal antibodies present were of the warm type in eleven patients and of
the cold type in seven patients.
With warm antibodies a well marked zone of inhibition was usually observed
when sensitized red cells were suspended in high concentrations of antiglobulin
serum, and the reaction was readily inhibited by the previous addition of very
small amounts of human 
globulin to the antiglobulin serum. Acidification of
the serum to pH 6.5 caused in most cases a moderate increase in the intensity
of sensitization in the indirect antiglobulin test. Previous heating of the serum
at 56 C. for 30 minutes did not prevent sensitization.
With cold antibodies, on the other hand, no inhibition of the antiglobulin
reaction took place in the highest concentration of antiglobulin serum used,
and the reaction was not inhibited by the previous addition of small amounts
of human globulin to the antiglobulin serum. Acidification of the serum to
pH 6.5 caused, in most cases, a considerable increase in the intensity of the reaction. Previous heating of the serum at 56 C. for 30 minutes completely prevented sensitization.
The separation of the abnormal antibodies of acquired hemolytic anemia into
warm and cold types cuts across clinical classification. Warm antibodies were
found in the majority of idiopathic cases; cold antibodies were present in some
idiopathic cases and in hemolytic anemia following virus pneumonia. Splenectomy was followed by sustained remissions in some of the idiopathic cases of
both the warm antibody and cold antibody varieties.
Submitted on February 10, 1953
Accepted on March 9, 1953
