The causative agent of DLHA is a cold-active immunoglobulin commonly denoted as the D-L autoantibody which demonstrates bi-phasic hemolysin capability of causing serious hemolysis even when the titer detection is low, which is because of its capacity to detach itself from the lysed RBCs and consequently bind intact erythrocytes according to the temperature changes. D-L antibodies are most commonly targeted against P antigens than I antigens and others expressed on the RBC membrane. The D-L hold on tightly to RBC surfaces during the peripheral circulation systems such as human extremities, where temperatures are likely cooler than in comparison to core body temperature. After successful attachment to RBC surfaces, the D-L then activates the complement cascade, leading to RBC membrane perforation (i.e., intra-vascular hemolysis phenomenon). Complement activation and consequent hemolysis would become reality if and only if binding-RBCs has travelled to the core part of the body at a warmer temperature around . Because of the reasons given above, the results of the direct antiglobulin test (DAT) with anti-C3 are highly likely to be positive while to be negative for anti-IgG or anti-IgM, only when the DAT is being performed at approximately and then incubated at around .
Donath–Landsteiner hemolytic anemia
Warm antibody autoimmune hemolytic anemia
Cold autoimmune hemolytic anemia
symptom of Congenital dyserythropoietic anemia
medical cause of Hemolytic anemia
Sickle cell-beta thalassemia
Twin anemia-polycythemia sequence
Hughes–Stovin syndrome