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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