| Project/Area Number |
18K07421
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Review Section |
Basic Section 52010:General internal medicine-related
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| Research Institution | Jichi Medical University |
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Principal Investigator |
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| Project Period (FY) |
2018-04-01 – 2022-03-31
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| Project Status |
Completed (Fiscal Year 2021)
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| Budget Amount *help |
¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Fiscal Year 2020: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000)
Fiscal Year 2019: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000)
Fiscal Year 2018: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000)
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| Keywords | 自己免疫性溶血性貧血 / クームス試験 |
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| Outline of Final Research Achievements |
Five to ten percent of patients with autoimmune hemolytic anemia (AIHA) have a negative finding on the direct antiglobulin test (DAT) and are difficult to diagnose. Most of these AIHA patients have amounts of red blood cell-associated IgG below the cut-off value of DAT. Comprehensive diagnosis and classification of DAT-negative AIHA can be made with additional tests of low-affinity IgG and IgA/IgM autoantibodies. However, 17% of patients with DAT-negative AIHA show negativity on all the above tests and are diagnosed with ‘clinically diagnosed DAT-negative AIHA’ following exclusion of other hemolytic anemias and responsiveness to steroids. This percentage could decrease to 4% if tests were done before treatments. Patients with this AIHA show relatively worse prognosis than patients with low-affinity IgG. When treating a patient with DAT-negative hemolysis, DAT-negative AIHA should be considered and tested in reference laboratories, especially before treatment.
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| Academic Significance and Societal Importance of the Research Achievements |
診断に苦慮することが多いクームス陰性AIHAの網羅的診断・分類法を確立し、それぞれの特徴やわが国における頻度を明らかにした。本検査法は、現在、わが国の臨床の場で活用されている。また、クームス陰性AIHAの17％に網羅的診断法では検出できない比較的予後不良な ‘臨床的に診断されたクームス陰性AIHA’ が存在することを明らかにした。機序の解明や直接的な検査法については今後の課題であるが、ステロイド治療前に検査を行うことで4％に減少することから、DAT陰性の溶血貧血患者を診る際には、クームス陰性AIHAも考慮して、治療前に検査を行うことを推奨している。
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