Journal of Autoimmune Disorders

The Spectrum of Underlying Diseases in Patients with Positive-Direct Antiglobulin Test

Background: The association between a positive Direct Antiglobulin Test (DAT) and malignancy has been recognized. However, there has been dissimilar data on the spectrum of underlying malignancies and the timing of occurrence.

Objective: To estimate the pattern of underlying diseases in adult patients with warm reactive autoantibodies over a 12 year-period.

Methods: All consecutive patients with positive-DAT were selected and a follow-up for concomitant or subsequent development of malignancy or infectious or autoimmune disease was conducted. The gel technique with 5 monospecific anti-human globulin agents: Anti-IgG, anti-IgA, anti-IgM, anti-C3c and anti-C3d were used.

Results: Between 2009 and 2019, 164 patients, 86 males and 77 females, were found to have a positive DAT due to warm autoantibody among 12200 patients subjected to testing. The mean age was 62 years. Seventy two patients had Autoimmune Hemolytic Anemia (AIHA). The spectrum of underlying disease included: Lymphoproliferative disorders (14%), myeloproliferative disorders (10.3%), solid tumors (18.3%), autoimmune diseases (11%) and infectious disease. The most frequently observed condition was myelodysplastic syndrome at all stages.

The strength of DAT reaction was correlated with the degree of hemolysis but not with the stage of malignancy. All patients with AIHA were given corticosteroids, 3 of them required second line rituximab.

Conclusion: A positive-DAT with or without AIHA suggest the presence of underlying malignancy, mainly hematological and even in early stages. All patients with MDS should be tested for DAT for diagnostic and therapeutic issues.

Author(s): Riad Akoum1*, Michel Saade1, Wassim Serhal2 and Emile Brihi3

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