COOMB'S TEST

= also known as
antiglobulin test
or
AGT

AUTOIMMUNE HEMOLYTIC ANEMIA

= rare type of anemia which results in the
development of antibodies against an
individual's red blood cells.
two kinds ofblood teststhat can detect
the presence of these antibodies.
= used in immunohematology and immunology.

a) direct Coomb's test

(direct antiglobulin testorDAT),
b) indirect Coomb's test
(indirect antiglobulin testorIAT)

Mechanism of lysis:
In certain diseases or conditions an
individual's blood may contain IgG antibodies
that can specifically bind to antigens on the
RBC surface membrane.
These circulating RBCs can become coated
with IgG alloantibodies and/or IgG
autoantibodies.
Complement proteins may subsequently bind
to the bound antibodies and cause RBC
destruction.

>Alloanitbody
- an antibody produced following introduction of
an alloantigen into the system of an individual of
a species lacking that particular antigen
- an antibody that reacts with an antigen from
a genetically different individual of the same
species,(example: thru transfusion reactions)
>Autoantibody
- an antibody active against a tissue constituent
of the individual himself. (self against self)

Antibodies are produced by B cells in two ways:

(i) randomly,
(ii) in response to a foreign protein or
substance within the body.
= In either case, the B cell is allowed to
proliferate or is killed off through a process
called clonal deletion.
* Normally, the immune system is able to
recognize and ignore the body's own healthy
proteins, cells, and tissues, and do not
overreact to non-threatening substances in
the environment, such as foods.

Sometimes, however, the immune system

ceases to recognize one or more of the body's
normal constituents as "self," leading to
production of pathological autoantibodies.
Autoantibodies attack the body's own healthy
cells, tissues, and/or organs, causing
inflammation and damage.
Some autoantibodies may also play a
nonpathological role; for instance they may
help the body to destroy cancers and to
eliminate waste products.

*Coombs Test
= done to check if antibodies have
developed as a result of some disease or a
consequence of blood transfusion.
Direct Coomb's test
= test for autoimmune hemolytic anemia
= also conducted on an Rh-positive new
born baby whose mother is Rh-negative.
identifies the presence of mothers
antibodies in Rh-positive baby (transferred
through placenta)

Indirect Coombs test

= used in prenatal testing
= used in testing blood prior to a blood
transfusion.
*most often done to determine for
reactions to a blood transfusion.

Direct Coomb's test

= conducted on a sample of RBCs from the
patient.
= detects antibodies that are already present
on the surface of RBC,
Indirect Coomb's test
= conducted on the serum;
= aims to detect antibodies against RBCs
that are present unbound in the patient's
serum that could potentially attach
themselves to the RBCs

Direct Coombs test:

a) blood sample is taken
b) RBCs are washed (removing the patient's
own plasma)
c) and then incubated with
antihumanglobulin (also known as
"Coombs reagent").
Indirect Coombs test:
a) serum is extracted from the blood sample
b) the serum is incubated with RBCs of
known antigenicity (RBCs with known
reference values from other patient blood
samples)

Interpretation of Test Results

Normal direct Coomb's test result
= negative test result. NO AGGLUTINATION
Abnormal result,
= positive direct Coomb's test result.
The presence of these antibodies could be due :
a) autoimmune hemolytic anemia,
b) Erythroblastosis fetalis
(Hemolytic Disease of the Newborn)
c) drug induced hemolytic anemia,
c) Chronic lymphocytic leukemia
d) transfusion reaction

 other conditions with (+) DAT

= mononucleosis,
= syphilis,
= high prevalence in patients with HIV antibodies
= ***senior citizens