The sera of four patients with chronic hemolytic anemia due to cold agglutinins deposited C′ globulins on normal red cells at 37°C. The circulating cells of the patients were heavily coated with C′ complex and were relatively resistant to C′ hemolysis by cold agglutinin. Such red cells were removed from the patients' circulation at an exponential rate with 51Cr t½ that varied from 7 to 19 days. Normal red cells were removed rapidly by hepatic sequestration during the first hours in the patients' circulation. Thereafter, a slower rate of abnormal destruction occurred which was associated with the accumulation of C′ complexes on the red cell and the development of resistance to C′ hemolysis by cold agglutinin. Normal red cells coated with sufficient C′ complex by action of cold agglutinins in vitro to produce resistance to C′ hemolysis by cold agglutinins demonstrated varying degrees of improved survival during the first hours in the circulation of three of the patients.
Robert S. Evans, Elizabeth Turner, Margaret Bingham, Richard Woods
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