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John V. Dacie, MD

Arch Intern Med. 1975;135(10):1293-1300.

Abstract
Warm-type autoantibodies of autoimmune hemolytic anemia (AIHA) are usually IgG but may be IgM or IgA. They are usually Rh specific. Cold-type antibodies are IgM or IgG (Donath-Landsteiner [DL] antibody). IgM antibodies are usually anti-I (occasionally anti-i) and DL antibodies anti-P.

The warm IgG antibodies do not fix complement (C); they cause red blood cell (RBC) destruction predominantly in the spleen as the result of interaction between antibody-coated cells and phagocytes. The cold antibodies are complement fixing; they cause RBC destruction either by intravascular lysis (complement sequence completed) or by interaction between C3-coated RBCs and phagocytes in liver and spleen.

Genetic factors, immunoglobulin deficiency, somatic mutation, viral infections and drugs, and failure of T-lymphocyte function, all probably play a part in breaking immunological tolerance and the development of AIHA.

Author Affiliations
From the Department of Haematology, Royal Postgraduate Medical School, London.

Footnotes
Received for publication March 5, 1975; accepted April 21.

Read before a symposium in honor of Lawrence E. Young, MD, Rochester, NY, Oct 4,1974.

Reprints not available.

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