There are many ways how to objectively determine the presence of anemia or in this case AIHA. One of the testes used is the Direct Anti-Globulin Test (DAT), otherwise known as the Coombs test. The goal of the test is to describe the presence of antibodies in the blood plasma or serum. By knowing the number of antibodies, it can be accurately rule whether the patient is suffering from AIHA or other forms of anemia or otherwise. It is often used to check whether the patient is suffering from transfusion reactions and other hemolytic diseases such as AIHA in this case. a blood sample is obtained, the blood sample is then mixed with Coombs reagent and the red blood cells agglutinate as a result. The testers then check on the antibodies and tell whether there is hemolytic anemia signs and symptoms involved.
The main implication of a positive DAT is that it indicates that the patient is suffering from a hemolytic form of anemia either due to drug-induced or autoimmune causes, among others. Now this does not always mean that it would be AIHA. A careful set of procedures involving differential diagnosis should be done first before finalizing the findings.
Hemolytic forms of anemia can be described in various levels. Tolerance may be advised to the patient if the symptoms are mild. The use of immunosuppressant drugs may be advised to help the patient adapt to the changes in blood composition or to the effects of the drug inducing the AIHA.
AIHA can be classified into symptomatic and laboratory-based. Symptomatic AIHA occurs when the subject’s blood is exposed to cold temperature and other anemia-triggering drugs in which anemia and hemolysis occurs. Laboratory-based types on the other hand only trigger signs and symptoms during serology and laboratory tests. AIHA can also be classified based on etiology under which warm, cold, and drug-induced AIHAs are included. The difference between this etiological classification revolve around the anti-IgG, anti-C3d, and incidence-related findings.
Comparison
Drugs are often involved as a mechanism in the production of autoimmune hemolytic anemias, positive DAT’s and immune-based hemolysis because there are certain drugs that alter and do not coincide with the body’s natural blood regulation function, thereby creating disturbances such as anemias.
The basis of DAT negative autoimmune hemolytic anemia is good considering it relies on the same principle of diagnosis only that it does not react to Coombs test. In such cases other forms of laboratory investigations presented may be used such as serology and other forms of antibody testing.
A systematic approach that can be used in laboratory investigation is one where all the variables including patient history and clinical decision making is involved. Using more standard tests followed by ones that are meant to narrow down the diagnosis would also prove to be systematic.
All of the tests can be justified as long as there are still doubts whether the patient’s signs and symptoms are not completely indicative of a certain type of disease or AIHA.
