Wednesday, November 26, 2025

Coomb's negative hemolytic anemia

 

Reference : ASH clinical news Sept 2025

1. First step to confirm Coomb's neg:  get enhanced DAT test to rule out Ig A, Ig M, low-affinity Ig G or Ig G antibody that binds to fewer epitopes.

2. Coomb's neg AIHA is rare 3-10 % of AIHA

3. Causes:

  •  Acquired: B12 def, infections such as malaria, review oxidative drug hx ( phenazopyridine, dapsone) 
  •  Genetic: Wilson's disease, enzymopathies, hemoglobinopathies, and membranopathies.
4. Tests:  smear evaluation, corrected retic count, B12, folate,, PNH, Eosin-5-malemide, Hb electrophoresis, G6PD testing. Some of these may be falsely neg after blood transfusion.



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