{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T13:38:37Z","timestamp":1773236317603,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Approximately 5%\u201310% of autoimmune hemolytic anemia (AIHA) cases are negative for direct antiglobulin test (DAT). We previously reported a classification system for untreated patients with DAT\u2010negative AIHA by quantifying levels of red blood cell (RBC)\u2010bound IgG. This study investigated the clinical utility of a novel diagnostic algorithm with a comprehensive classification system and characterized each subgroup in DAT\u2010negative AIHA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>We assessed 637 patients with undiagnosed hemolytic anemia using our diagnostic algorithm and classification system, which was based on RBC\u2010bound IgG levels and results of column method\u2010DAT before and after washing RBCs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients were diagnosed with DAT\u2010negative AIHA with 97% sensitivity and 84% specificity when the laboratory tests were performed before treatment and classified into the following six categories: tube DAT\u2010negative, low\u2010affinity IgG, double DAT\u2010negative, IgA\u2010 or IgM\u2010positive, low\u2010affinity IgM, and s\/o non\u2010AIHA. The first three types were major conditions and accounted for 76% of DAT\u2010negative AIHA cases. Based on multivariate analyses of idiopathic DAT\u2010negative AIHA (<jats:italic>n<\/jats:italic>\u00a0=\u00a071), platelet count and albumin concentration were significant factors for survival at 1\u2010year follow\u2010up. The low\u2010affinity IgG group showed the highest platelet count and albumin levels, better response to steroids, and higher 1\u2010year survival rate than those in other groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Our classification included DAT\u2010negative, IgA\u2010driven, and warm\u2010IgM AIHA categories, which were atypical forms of AIHA with the severe onset and increased risk of relapse. When treating a patient with DAT\u2010negative hemolysis, atypical AIHA should be considered and tested in reference laboratories, especially before treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.16709","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T22:09:06Z","timestamp":1634767746000},"page":"205-216","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Diagnostic algorithm for classification and characterization of direct antiglobulin test\u2010negative autoimmune hemolytic anemia with 1\u2010year clinical follow\u2010up"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1311-3755","authenticated-orcid":false,"given":"Toyomi","family":"Kamesaki","sequence":"first","affiliation":[{"name":"Division of Support in Community Medicine, Center for Community Medicine Jichi Medical University  Tochigi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Immune hemolytic anemias (ed 2)","author":"Petz LD","year":"2004"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcmd.2013.12.003"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-06-583021"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23356"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21336"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000488753"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2009.02130.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-553X.2011.01397.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2005.04.005"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14478"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2019.100648"},{"key":"e_1_2_8_13_1","unstructured":"MitaniK HarigaeH NishimuraJ UedaY TakamoriH WadaH et al. A reference guide for diagnosis and treatment of autoimmune hemolytic anemia. The Ministry of Health Labor and Welfare Study Group on dyshematopoiesis 2020.http:\/\/zoketsushogaihan.umin.jp\/file\/2020\/09.pdf."},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1978.18378205146.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1984.24685066803.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.00946"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2015.128991"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24665"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2005.05955.x"},{"key":"e_1_2_8_20_1","first-page":"2","article-title":"Autoimmune hemolytic anemia: clinical correlations and biological implications","volume":"3","author":"Schwartz RS","year":"1966","journal-title":"Semin Hematol"}],"container-title":["Transfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.16709","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/trf.16709","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.16709","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T08:22:23Z","timestamp":1693210943000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/trf.16709"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,19]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.1111\/trf.16709"],"URL":"https:\/\/doi.org\/10.1111\/trf.16709","archive":["Portico"],"relation":{},"ISSN":["0041-1132","1537-2995"],"issn-type":[{"value":"0041-1132","type":"print"},{"value":"1537-2995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,19]]},"assertion":[{"value":"2021-01-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}