The improved demonstration of circulating antibodies in hemolytic anemia by the use of a bovine albumin medium.

T HE pathogenetic mechanisms of the excessive hemolysis that occurs in both familial and acquired cases of hemolytic anemia continue to be the subject of much discussion and investigation. Several theories have been advanced to explain these processes, in which spherocytosis of the red cells commonly occurs. In 1938, Dameshek and Schwartz’ first demonstrated that the spherocyte was not necessarily the result of an hereditary defect of erythropoiesis, but could be produced experimentally by means of an immune hemolytic serum. These studies indicated that a circulating hemolytic antibody might be the cause of the excessive hemolysis and of the spherocytosis found in many cases of acquired hemolytic anemia and possibly in congenital spherocytic hemolytic anemia as well. Further studies2 demonstrated that various types of antibodies, both hemolysins and agglutinins, caused injury to red cells with resulting complete breakdown (hemolysis) or incomplete breakdown, i.e. spherocytosis. By means of the customary technics for demonstrating hemolysins and agglutinins using salt solution as a diluent, these antibodies were found in only occasional cases of acquired hemolytic anemia, usually of the acute variety. The independent demonstration in 1944 by Race3 in England and Wiener4 in this country of a so-called “blocking” or “incomplete” type of Rh antibody demonstrable only in a serum medium raised the possibility that circulating antibodies of this type might also be detected in patients with hemolytic anemia. Diamond and Denton’ in their investigations of Rh antibodies suggested the use of bovine albumin as a diluting medium, and we have used this method in our search for antibodies in cases of hemolytic anemia. By this method, abnormal iso-antibodies have been discovered in a number of patients with hemolytic anemia in whom negative or questionable results were obtained by the ordinary technics.