Coombs’ Test

The Coombs’ test is used to detect antibodies that act against the surface of your red blood
cells. The presence of these antibodies indicates a condition known as hemolytic anemia, in
which your blood does not contain enough red blood cells because they are destroyed
prematurely. A healthy red blood cell lives for about 120 days; in people with hemolytic
anemia, red blood cells are destroyed long before the 120-day marker. Sometimes, bone
marrow can compensate for the early destruction of red blood cells by working overtime to
make more of them. However, this extra effort may not be enough to combat hemolytic
anemia.

Hemolytic anemia can either be inherited genetically or acquired. An acquired form,

autoimmune hemolytic anemia (AIHA), is present in about 10% of people with lupus and
results from an immune system attack on your red blood cells. People with AIHA may
experience weakness, dizziness, fevers, and a yellowed complexion. Treatment calls for high
doses of steroids such as prednisone, which may be supplemented with immunosuppressive
medications such as azathioprine (Imuran).

There are two types of Coombs’ tests: direct and indirect. The direct Coombs’ test, also
known as the direct antiglobulin test, is the test usually used to identify hemolytic anemia.
[The indirect Coombs’ test is used only in prenatal testing of pregnant women and in testing
blood prior to a transfusion.] For the direct Coombs’ test, blood is drawn from the vein in
your arm and then “washed” to isolate your red blood cells. The red blood cells are then
incubated (combined in a controlled environment) with a substance called Coombs’ reagent.
If the red blood cells clump together (a process called “agglutination”), then the Coombs’ test
is said to be positive.