A Case of Agglutination and Hemolysis of Erythrocytes Caused by the Patient’s Own Plasma

The aim of the work was to study the agglutination and hemolysis of erythrocytes under diff erent conditions in vitro in a patient with unknown cause of anemia and concomitant secondary instability of endoprosthesis.

Material and methods. One percent (1%) suspension of erythrocytes of a woman, 61 years old, A (II) Rh- (negative) presented with anemia was incubated with her serum and plasma at pH 7.3, pH 5.8 and 9.0, as well as with IgM α and β antibodies. Unithiol was used to destroy IgM antibodies. The samples were incubated for 12 hours at 37° C, and the presence of the agglutination and hemolysis was evaluated.

Results. The incubation of the plasma with unwashed erythrocytes of the patient led to the agglutination of the erythrocytes and the usage of the complement led to the hemolysis. After inactivation of IgM in the plasma the agglutination was absent and the hemolysis was present under usual conditions and at pH 5.8, whereas at pH 8.0 the hemolysis was attenuated, however a slight degree agglutination appeared. The usage of the complement led to the agglutination and the hemolysis, absent at pH 8.0. The plasma incubated with washed red blood cells and the complement led to the hemolysis. The incubation of the serum with washed erythrocytes led to the hemolysis at pH 5.8, attenuated after the usage of the complement. The contact of terbinophine with plasma and unwashed red blood cells led to the absence of both the hemolysis and the agglutination. Candida lusitaniae growth was detected in the plasma.

Conclusions. The agglutination of unwashed erythrocytes by own plasma, attenuated in the alkaline medium and enhanced in the acid medium, as well as the absence of the agglutination after the usage of terbinophine and the hemolysis in the presence of the complement might be the signs of mycogenic and autoimmune origin of anemia with the activation of autoimmune complement – binding antibodies.