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Would you consider a positive DAT and indirect Coombs test, persistent and consistent with IgG warm antibody, clinically significant in absence of hemolysis?
Patient with iron deficiency anemia from heavy bleeding from advanced uterine cancer. No evidence of hemolysis by smear or CBC profile.
Could such antibodies be paraneoplastic?
Answer from: at Academic Institution
Yes, a positive Direct and or Indirect Antiglobulin test can potentially be a paraneoplastic phenomenon (Akoum et al., Hematol Med Oncol, 2022) and yes, it is always “clinically significant” in the sense that it requires follow-up investigation even if it is not “clinically s...
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Answer from: at Community Practice
Up to half of patients with red cell auto-antibodies (i.e., true positive DAT/direct Coombs test) are not experiencing hemolysis. After iron repletion in this patient, the best way to determine the degree of hemolysis and whether treatment is needed is by the stability of the hemoglobin and the reti...
Answer from: at Community Practice
Agree with both comments. The clinical setting and associated laboratory findings (particularly retic counts after iron repletion, LDH, indirect and total bilirubin, and haptoglobin) are key issues. Sometimes the laboratory data are conflicting, complicating the evaluation, and clinical trajectory i...