hemolytic anemia, Viklican autoimmune tilami, which are straightened against vlast erythrocytes, definitely not zyasovany. However, it is transmitted, as a factor (for example, virus, abnormal block), so change the erythrocytes, so that the organism of the blood cells is already "like a stranger" and joins them in the struggle for additional anti-til. It is obvious from the theory that the antihyperthrocyte antibodies are directly corrected in the process of developing abnormal blood cells with plasmas in case of malignant ailments. Such a bile, just like "vipadkovo" itself, can give a reaction, which can be victorious for setting a diagnosis (for example, viral pneumonia, Yak seemingly, yes, I am a positive Wasserman reaction, a positive Paul - Bunnel reaction and a cold agglutination reaction).

є two head type autoantitil in case of hemolytic anemias, and itself: warm antibodies (react at 37 °) and cold antibodies (reactive health of those who are able to adapt to zero temperature in the world). Heat antibodies occur more often than cold weather. Dacie know that heat hemolysis occurs in 2 times more often than cold weather. Hemolysis and agglutinin are not fundamentally different antibodies: the stench grows only in the character of the work. Agglutinin agglutinate erythrocytes, and hemolysis is more subtle to the collapsible process of hemolysis (complement!). Autoantitila, fixed on erythrocytes, set up the erythrocyte-globin complex. The whole complex appears behind the additional antiglobin test of Coombs.

Coombs test to be carried out with Coombs' syrovatka, to prepare a rabbit sensitized by a syrovaty people, against which in a rabbit syrovattsi antibodies are established. When there is such a sensitized cell on the human erythrocytes, there is an infusion of agglutination, as the receptors of the erythrocytes are occupied by blocking antibodies. So, as the blocking antibodies resemble human beings, the stench gives an agglutination with a rabbit's syrovat, sensitized to human plasmas and revenge prescriptions. The reaction is called the Coombs breakdown; for hemolytic anemia on the ground of autoimmune bodies (Lo tit), it is very specific (details of div. from Maier).

Zagalom with hemolytic anemias With the primary lesions of the erythrocytes, the Coombs' test is negative, and with the damages it is positive. However, this is a rule of thumb: a hibopositive Coombs' test is known in crises of constitutional hemolytic anemias, and in a weak stage - also in cases of splenectomy, with rheumatic polyarthritis, sarcoidosis, frequent Naturally, in case of near-haemolytic anemias without coverage of autoimmune bodies, it is negative.

hemolytic anemia, Victims of autoimmunity, you can use:
a) gostrі, підгострі і chronic forms, And also on
b) idiopathic with non-homeopathic etiologic and c) symptomatic [cold pneumonia (cold), chronic lymphatic leukemia, reticulosarcoma, lymphosarcoma, systemic heart disease, cold spіvrobіtniki)).
c) symptomatic [viral pneumonia (only cold aglutinin), chronic lymphatic leukemia, reticulosarcoma, lymphosarcoma, systemic cervical vovchak (also heat, earlier cold aglutinis), cold syphilis

Clinical hemolytic anemias The development of autoimmune bodies is even more flexible, and it is unlikely that it is possible to create a clever picture. Individuals of the growth rate and both of the articles should be coped with equal measure. All the same idiopathic forms such as nibi are often spared in women (Sacks and Workman).

Clinical picture of idiopathic form Change in the fallowness due to the severity of the disease. In chronic cases, it often happened step by step, the ailment was drawn by a lot of rock with frequent sharpening. The severity of the anemia in the presence of the hemolysis stage. The decrease in hemoglobin is reduced to 10%, in those drops, hemoglobin is trivial to decrease by 50-60%. Intensity of reticulocytosis and hypochondriacal growth of the sclerosis and sowing leads to the degree of hemolysis. Bilirubin in the section is even worse, so as it is not necessary to pass through the nyrcs, ale hemoglobinuria is more severe. Selezinka in chronic drops is more often than not, and you can reach even more significant changes, but in those drops it is not easy to feel it. The stove is rare if not improved.

At the blood in great vipadkiv prevent macrocytosis, in gostrykh stadiyah there are also a lot of microcytes, rarely with normoblastosis and polychromasis, leukocytosis can reach 30,000, thrombocytes are normal. In some cases, however, thrombocytopenia is common. Evans will explain the effects of an overnight appearance of antibodies against platelets, as well as an overnight hemolytic anemia and thrombocytopenia on the ground of autoimmune bodies - Evans syndrome (Evans). Osmotic resistance is slightly reduced, albeit not in this world and not so permanently, as with constitutional globular cell anemia. Test for durability before heating (Hegglin-Maier) after 6 years or even a slight hemolysis (very cautious), a little less world, less anemia Markiafavi. In sechі there is also hemosiderin.

With no free antigens in medical practice most significant come to three types of blood agglutinogens. One of them є type is indicative for the manifestation of the Rh factor: if it is present on the membrane of the erythrocyte, diagnoses the Rh + blood group, if it is visible - Rh-. Even before the storehouse of Rh-negative blood, the erythrocytes are consumed with Rh + agglutinogens, the organism of launching the reaction of the immune system and initiating the viroblation of the antibody to the same antigen, which becomes the cause of pathological conditions.

DOVIDKA! The Rh factor is a foldable multi-component system with dozens of antigens. Most often they are detected - type D agglutinogen (85% of vipads), as well as E and C.

Conduct the Coombs' test only when it is clearly indicated. A long list of reasons for a Coombs test:

• planuvannya and vedennya vagіtnostі (daddy mayut rіzniy Rh);
• donation and preparation before blood transfusion (the distribution of blood according to Rh is not less pernicious, not less according to the AB0 system);
• planned surgical intervention (on the basis of blood loss for additional blood transfusion);
• diagnostics of hemolytic ailments.

Most of the specific information should be deposited according to the type of pre-treatment carried out.

Direct Coombs test

The direct test allows the appearance of antibodies on the surface of the erythrocytes. The price is necessary for diagnostics in the already obvious hemolytic pathologies:

• autoimmune (erythrocytes and hemoglobin ruin as a result of an attack by antibodies to the organism);
• medications ( pathological process launching drugs type hinidin or procainamid);
• post-transfusion (in case of blood group prolapse during transfusion), as well as in viglyadi Rh-conflict with vaginosis (neonatal erythroblastosis).

DOVIDKA! Hemolithic anemia is a disease, associated with the early rupture of the erythrocytes as a result of hemolysis, which leads to insufficient blood saturation and hypoxia of the brain and / or internal organs.

Hemolysis of blood elements is susceptible to oncological, infectious, rheumatic ailments, so a direct Coombs test can be detected as a precursor for diagnostics pathological camp... With a whole varto memory: from the point of view of the analysis, it is not the result of the hemolysis, but a drive for the additional adjustment.

Indirect Coombs test

An indirect test is often stagnant to prevent pathological situations. You will need additional help in detecting antibodies in blood plasma, which is necessary for assessing the confusion during transfusion and diagnostics of rhesus rhesus-conflagration rhesus-conflagration after an hour of vaginosity.

More than 80% of people may have a positive Rh factor (Rh +), apparently, trochi less than 20% are Rh-negative. As Rh-mothers develop Rh + ditina, the organisms start to develop antibiotics, attack the erythrocytes of the fetus, provoke hemolysis.

Due to the fact that there are 12-15% of "different-cut" people who love the disease, the risk of hemolytic ailments of new women is great, but in reality only 1 out of 25 children are affected by women who are sensitive to 1 Chastkovo tse was pondered by the first rhesus-positive child to wake up not to vicious aggression to the mother's organisms; the number of attacks on a friend and oncoming children is important. It is the same principle as in case of extreme sensitization to the point of allergen.

At the first contact, the reaction should not be seen. The body only knows a new antigen for a new antigen, it is antigenic to the IgM class, as it seems to be a fast immune response, but sometimes it penetrates through the placental bar into the child's blood. All pathological reactions are manifested with repeated "development", if the body regains the anti-IgG class antibodies, easily penetrate into the bloodstream of the fetus, triggering the process of hemolysis.

Indirect Coombs test with vaginosti allowing the emergence of antibodies in the body of the mother and often at the ear stage of sensitization. Positively, in the course of staging on the field with a few thousand pre-recorded titers of antibodies and general hospitalization for 3-4 hours before the half-hour.

DOVIDKA! The insanity behind the Rh factor in the mother's country is not recognized, hemolytic ailments develop only in the child. In important cases and in the presence of a quick reaction, the fruit can be lost in the womb, or at once the message of the people.

Preparation before the procedure

For diagnostics vikoristovoyt venous roof... Special trial preparation before the Coombs test is not required. Become familiar with the standard set of rules before taking blood from veins for analysis:

• for 3 add alcohol, medications (if possible);
• Plan for the last few days, not 8 years before taking blood for analysis;
• for 1 year, you have been reviewed from the city, physical, pink and emotional navantages;
• before the procedure, drink a bottle of pure non-carbonated water.

The method of monitoring the test on the reaction of hemaglutination.

When carrying out a direct test On the occasion of the blood, they pour in the prepared antiglobulin syrovatka with vidomny indicators, it is necessary to change the amount of antiglobulin antiglobulin for an hour and to reconsider for agglutination, as it is established with the presence of antiglobulin antibodies on the erythrocytes. Rivn in the place of agglutination is diagnosed for additional agglutination of the titer.

indirect test Coombsa can use a methodology that is more folding after the end of the day. In the case of blood loss, inject antigenic erythrocytes (with the Rh factor) and only when they are manipulatively add antiglobulin antiglobulin for diagnostics and titer of agglutination.

Doslіdzhennya results

At normi i is straight, i indirect Coombs test guilty to give a negative result:

• negative direct test to indicate those with specific antibodies to the Rh factor, linked to erythrocytes, in the blood from the daytime and cannot be the cause of hemolysis
• the indirect test is negative; it shows that there is no antibody to the Rh factor in the blood plasma as well as during the day; the fact to indicate the confusion of the donor's blood with the recipient's blood (aka the blood of the mother and the child) according to the Rh factor.

It is a positive test of Coombs to speak about the fact of Rh sensitization to the body, which is the main reason for Rh conflagration in the case of blood transfusion, or in case of a child with an infantile rhesus status. In general, the results are saved in an unprecedented stretch of 3 months (term of life of erythrocytes). If the cause was autoimmune hemolytic anemia, then a positive test can be passed over the patient with a stretch of decimals (in a number of vipads - all life).

DOVIDKA! The antiglobulin test is very sensitive, but very little informative. It is not a restructuring of the activity of the hemolytic process, it is not due to the type of antibody or the cause of the pathology. For rejection of a larger picture, a lyuchic drug is obviously indicative of additional information (microscopy of blood, foreign and biochemical analysis, rheumatic test, SHOE, rhyme of zaliza and feritin).

The stage of sensitization can be made from viraz (from “+” to “++++”), but only in the case of the title:

• 1: 2 - low value, not being safe;
• 1: 4 - 1: 8 - ear of development of immunological reaction; not imagining that they are not safe, ale vimagaє post_aynogo control;
• 1:16 -1: 1024 - yaskrava form of sensitization, followed by inaccurate entry.

The reason for the positive test is:

• transfusion of untyped blood (for good measure), if the Rh factor of the donor and recipient does not get lost;
• Rhesus-conflict in case of vaginosity (as the storage of antigens in the blood of the father and mother does not get lost);
• autoimmune hemolytic anemia - as vrodzhena (pervinna), as well as secondarily, as a common ailment (Evans syndrome, infectious pneumonia, syphilis, cold hemoglobinuria, lymphoiditis);
• drug hemolytic reaction.

Zhodna with pererakhovanih problems cannot be seen by a patient without lykarskoy help. All vypadki know terminova consultation, staging on the oblast or an extraordinary hospitalization.

UVAGA! In small cases, a positive Coombs test is possible. The reason for this can be part of the transfusion of blood, as well as a number of illnesses: rheumatoid arthritis, Chervoniy vovchak, sarcoidosis. Also, the phenomenon can be facilitated by the visualization of the spleen, as well as during the ruptured course of the reaction (part of the destruction at once, the appearance of the wandering houses).

The Coombs' test is a central analysis of blood, which can be carried out, to find out, to take revenge on the blood of antibodies, which may not be safe. Anti-antibodies stick to the erythrocytes and can invade the immune system, and also create them in other ways. In medical terminology, it is also called the antiglobulin test (AGT).

Tipi Coombs Samples

There are two types of Coombs' probes - straight and indirect.

Direct Coombs test, It also appears as a direct (PAT), auto-antibodies, which are attached to the surface of the erythrocytes. Some antibodies are violated in the body in cases of sickness, or when taking medications, such as procainamid, methyldopa or hinidine.

Dani antibodies are not safe, that is why they smell anemia, ruinous erythrocytes.

The Danish test is used to diagnose the cause of anemia.

In the norm, Coombs' reaction is negative.

Positive for:

• hemolytic ailments of new-born women;
• autoimmune hemolysis;
• hemolytic transfusion reactions;
• lykarskoy and immune hemolytic anemia.

Indirect Coombs test Also, it’s like at home, it’s victorious for detecting antibodies to erythrocytes, so it’s taking place in syrovaty blood (syrovatka is the price of a hole in the blood, because it’s overflowing for that, as it’s like red blood flowing in blood).

An indirect Coombs' test is stagnant during blood transfusion to determine whether the donor's blood is stored with the recipient's blood. The price is called a breakdown for madness, it will help you to be able to react to the donor's shelter. Daniy analiz also recommendations for vaginal women. Deyakі females may have anti-IgG class, as they can penetrate through the placenta into the roof of the fetus and be given a new neonatal disease, having experienced hemolytic illness, as a result of hemolytic anemia.

procedure

The blood is taken for the help of the syringe from the vein, slurry the side of the valley or on the side of the lick. I will puncture before the cymbal is disinfected, and after taking the blood analysis, apply a clean gauze or cotton wool.

The shelter will be cleaned in the laboratory, at the same time the red blood will be recovered. At a later time, the last time to hear from the intake of new reagents and Coombs', which protistavlyaetsya. Iaksho do not trap agglutination (angry bloodshot bloodshed), this means a positive result.

However, if the test is negative, it means that there is an antibody in the blood, and it is against the erythrocytes. Tse can vkazuvati on rіznі ailing Such anemia (which is natural, so it is provoked by the intake of medications), syphilis, or microplasmic infection. If you reject the results in a viable license, it should be considered a vidpovidnaya lykuvannya.

Video

Abo razchinenih in plasma.

Sinonymi: antiglobulin test, Coombs test, AGT, indirect / direct antiglobuline test, IAT, NAT, DAT, indirect / direct Coombs test

Coombs test - tse

analysis, for the additional benefit of immunization and antibodies to erythrocytes.

See Proby Coombs

• direct Coombs test- the appearance of antibodies fixed on the surface of the erythrocytes. It is carried out in case of adolescence on autoimmune hemolytic anemia, hemolysis in case of autoimmune ailments, on receipt of symptoms (methyldopa, penicilin, hinin), for transfusion of blood and hemolithic ailments

Eritrotsiti boule sensibіlіzovanі in vivo - to them Vzhe mіtsno prikrіplenі antitіla and dodavannya antіglobulіnovoy sirovatki (anti-IgG) viklikaє skleyuvannya sensibіlіzovanih klіtin scho i seen neozbroєnim eye.

• indirect Coombs test- detect anti-arthrocytic antibodies in blood plasma, test before blood transfusions and during vaginosis.

Antierythrocytic antibodies - a type of autoantitil, tobto antibodies against the same tissue. Autoantitila vinikє in case of pathological reactivity of the immune system to a drug, for example, to a high dose of penicillin.

Erythrocytes on their surface have different chemical structures (glycolipidi, tsukri, glycoprotein and protein), in medicine antigens... Lyudina will use her father's antigen map for skin hearts of blood.

The antigens are united in the group and for the whole shelter to be divided into the group - by system AB0, Rhesus, Kell, Levis, Kidd, Duff... The most significant ones in the robot's doctor are AB0 and the Rh factor (Rh).

system AB0

Rh-belonging people start to show the same antigens. An especially important antigen of erythrocytes is antigen D. If it is present, then we speak about Rh-positive blood RhD, and not even about Rh-negative Rhd.

Even before the antigens of the erythrocytes appear as antigens, then the erythrocytes collapse - hemolysis.

Shown before holding direct antiglobulin test

• primary autoimmune hemolytic anemia
• hemolytic anemia with autoimmune, swollen, infectious diseases
• lykarska autoimmune hemolytic anemia
• post-transfusion hemolytic anemia (days - months)
• hemolytic ailment of a newborn (insanity according to one group of blood)

Shown before holding indirect antiglobulin test

• before blood transfusions
• with vaginosti Rh-negative woman

Autoimmune hemolytic anemia

Autoimmune hemolytic anemia (pervinnia)- classic autoimmune illness for unidentified reasons. Allowing for destruction in the process of interaction on the basis of the immune system, which leads to the release of vlast erythrocytes as strangers. Clitini produce antibodies to the IgG class (react at 37 ° C) and / or IgM (at 40 ° C), when attached to the surface of the erythrocyte, launch a number of enzymes (the complement system) and “feed” the nucleus of the erythrocyte until hemolysis.

Symptoms of hemolytic anemia

• vtoma, impaired weakness, gratitude
• zadishka
• belly beat, nudota
• dark color
• back pain
• zhovtyanichne farbuvannya shkіri і mucous membranes
• improvement of liver, spleen
• Decrease in the number of erythrocytes and hemoglobin in the external blood analysis

Positive result straight Coombs' probes 100% support for diagnosis of autoimmune hemolytic anemia, leading to autoimmune walking. An overnight negative result does not give an opportunity to remove the diagnosis.

Secondary autoimmune hemolytic anemia and positive Coombs' test can be found with such ailments:

• systemic chervona vovchanka
• Evans syndrome
• macroglobulinemia of Waldenstrom
• paroxysmal cold hemoglobinuria
• chronic lymphocytic leukemia
• limfomi
• infectious mononucleosis
• pneumonia mycoplasma infection
• syphilis

The positiveness of the antiglobulin test in case of certain illnesses cannot be attributed to the diagnostic criteria, but only from the symptoms of illness.

Hemolytic ailment of the new neoplasm

Cause hemolytic ailments of the new genital - incompatibility of blood groups in mother and fetus, in most cases according to the rhesus system, in singles - according to the AB0 system, casuistic - according to the other antigens.

Rhesus-conflit develops, even if a Rh-negative woman has a bed of Rhesus-positive daddy.

Infections in the newborn develop only in the same way, since the mother has already violated antigens to the first antigens, when there is an increase in vaginities, abortions, abortions, blood transfusions. best common reason launching the synthesis of antibodies to antigens of the erythrocytic sheath - canopy (fetal bleeding). The first canopy in the main pass without delay, ale from the onset - fraught with hemolytic ailment of the newly born in the first days of the nation.

Symptoms of the hemolytic ailment of the newborn

• zhovtushn_st shkіri
• anemia
• wickedness of children and mules
• improvement of liver and spleen
• ruin dikhannya
• all over the place
• stimulation and action of the central nervous system

Anemia due to blood transfusion

Indirect Coombs test to carry out before blood transfusions for the assessment of the madness, and direct Coombs test- nyogo in case of adolescence for post-transfusion hemolysis, so if symptoms are evident, such as fever, chills, watering (read below). Meta-analysis is the detection of antibodies to transfuse erythrocytes, which have linked up with erythrocytes having taken blood and caused post-transfusion hemolysis, as well as the immediate visualization of donor erythrocytes from blood circulation in the recipient.

Symptoms of a hemolytic reaction to blood transfusion

• temperature adjustment
• hang on shkіri
• back pain
• chervone zabarvlennya sechі
• nudota
• dirty

Decryption of the Coombs probi

Varto nagadati, the principles of the rules for decoding direct and indirect antiglobulin test are the same. The only difference is the growth of antibodies - in the blood, or even on the red blood cells - on the erythrocytes.

• yaksho direct Coombs test is negative- it does not mean that on erythrocytes do not "sit" anti-til і the cause of the symptoms needs to be discussed і to conduct an indirect Coombs test
• if a positive result of Coombs' test was revealed by blood transfusion, infection, if - positivity can be up to 3 months (an hour of life of erythrocytes 120 days - 3 months)
• positive result of antiglobulin test in case of autoimmune disease

Normy Coombs' Probe

• direct Coombs test- negatively
• indirect Coombs test- negatively

A clearly positive result is seen in a number of plus points from one to one (+, ++, +++, ++++), and only in a digital view - 1:16, 1: 256, etc.

4 facts about Coombs' probes

• for the first time in Cambridge in 1945 rotsi
• sensitivity threshold - not less than 300 fixed antibody molecules per one erythrocyte
• the number of antibodies trigger hemolysis - individually for skin people (from 16-30 to 300)
• the dynamics of the other laboratory indicators of hemolytic anemia (hemoglobin, bilirubin, reticulocytes) can normalize, and Coombs's test can be lost on the same

Incomplete antiglobulin test

• it is not possible because of the strength of the link between the antigen and the antigen
• inadvertently the amount of knitted antibodies
• not specific type of antibody
• the positiveness of the Coombs test is not possible due to the significant reason
• 0.5% of healthy people may have a positive Coombs test without any signs of hemolytic anemia
• do not go to monitor the success of the treatment, the splinter does not even include the activity of hemolysis of erythrocytes

- Doslіdzhennya, as additional help in the presence of different anti-rithrocytic antibodies in the blood. Such an antiglobulin test allows the detection of antibodies to vaginal women.

In addition, it is allowed at the cob stage to diagnose hemolytic anemia in newborn children with Rh-conflict. Tse dopomagaє zapobіgti ruynuvannyu erythrocytes, necessary for normal blood formation. The Danish test was made in 1945 by Robert Coombs, after which I renamed it.

The Coombs' test is a smart way of thinking, which allows you to quickly diagnose damage in blood-forming processes in both grown-ups and children.

Check the onset of such tests:

1. Direct Coombs test- Allowing the presence of antibodies, which take place on the surface of the erythrocytes. You should also be aware of the possibility of being diagnosed with hemolysis, autoimmune hemolytic anemia, and autoimmune illness. In addition, there is a drug therapy drugs based on chinin, penicilin or methyldopa or for blood transfusion. To reject more accurate results, you need to see what kind of person you want for 1 day before you wait.
2. Indirect Coombs test- a test, with the help of which it is possible to detect anti-rithrocytic antibodies in plasma. It should be done during vaginosis and before blood transfusions. Antiiterithrocytic antibodies are found in the blood of people with reactive robotic immunity, or even a reaction to deyaki lykarski zasobi... For more accurate vivchennya carried out at once a number of parkans with an interval of 2 years.

Shown before holding

The Coombs test is carried out only when there are serious indications. Tse the road і trivial doslіdzhennya, like є a specific test.

The name is shown for the first time in the next situation:

1. With blood transfusion... The test allows for the significance of the recipient's shelter in the body of the people, as well as donation. In this case, it is necessary to read the material of both the donor and the recipient. It is important to determine the nature of antibodies, and even in times of insanity in the body at a rhesus-conflict to collapse immune system... Tse lead to the development of serious illnesses, and in some cases, death.
2. front surgical involvement, If you see blood loss... Try to make sure that you immediately enter a different shelter for the renewal of the body.
3. For rhesus sensitization. Rhesus is a specific antigen, a kind of wine in the organisms of the skin of a woman for an hour of vaginosis. Well, the mother has a positive rhesus, and the dad has a negative one, or navpaki, it’s bad for the child, it’s not good for the child. I will take away the mother's rhesus, the great risik of sensitization. This phenomenon is characterized by changes in the blood of mother and child. It can become as soon as the hour is brought to the fetus, so it is in the process of raising.

As soon as in the organism of the vaginal woman the rhesus-conflict is in the body, then the immunity of the mother will start alien tilo... Through the tse is a great risik of that, which is more likely to be attacked.

As a result of such actions, the baby may develop serious pathologies. Most often, erithroblastosis is a phenomenon, when the organism of a child can not be enough for a number of erythrocytes.

In addition, through the Rh-conflict, the fetus can die in the womb, or immediately after the nation. With the right approach to the liking of such serious inheritances, it is easy to be unique.

Vidhilennya vid norms

In case of a positive result on the Coombs reaction, the drug should be removed from the antibodies in the blood to the erythrocytes. It’s worth talking about those who donor’s shelter cannot be confused with the patient’s blood.

Also, a positive result is diagnosed in the body of the vagina. Rh-negative blood Then in the її organizmі there is an antibody to the blood of the fetus.

It’s worth talking about rhesus-conflicts, which is in the region of a respectful approach to the introduction of vaginosity from the side of the doctor, as well as displaying all the prompts and recommendations from the woman.

Even though antibodies are present in the blood of the child, hemolytic ailments of the newborn are diagnosed. In such a way, repeated dosage is carried out, so that it is possible to increase the amount of citrate antibodies in the shelter of the mother's mother.

Can be accelerated in Coombs' test

Coombs' test is to achieve a safe dosage, which allows a number of autoimmune diseases to be diagnosed at the cob stages. Wono rіdko wiklikaє accelerated, wake up the negative inheritance of being tied with a blood fence.

Stink in:

• Bleeding chi bleeding pid shkiru
• Blocked and obscene
• infectious

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