Robert Royston Amos ‘Robin’ Coombs was an influential immunologist who developed what became known as the ‘Coombs test’. First described in 1945, the test identifies incomplete antibodies in auto-immune haemolytic anaemia and is part of the standard cross-matching procedure to prevent transfusion reactions due to incompatible blood. It is also crucial in diagnosing haemolytic disease of the newborn.
The story of the discovery goes back to 1944, when Robin Coombs began work for a PhD in the pathology department of the University of Cambridge. This brought him into contact with Rob Race [Munk’s Roll, Vol.VIII, p.403] and Arthur Mourant [Munk’s Roll, Vol.X, p.348], who were then working on the recently discovered rhesus blood group system, incompatibility of which between mother and foetus gave rise to haemolytic disease of the newborn. Race and Mourant realised that the serology of the rhesus blood was atypical in that in addition to agglutinating anti-D antibody there was a variant, likely to be of clinical importance, known as ‘incomplete antibody’. Robin Coombs became interested in the nature of incomplete antibody and observed initially that, although not agglutinating red cells, it altered their electrophoretic properties. According to Arthur Mourant a ‘brilliant feat of intuition’ occurred when Robin Coombs was returning one evening to Cambridge on an ill-lit wartime train, reflecting on the problem of why certain anti-red cell antibodies did not produce direct red cell agglutination. Coombs realised that a second ‘bridging’ antiglobulin reagent might make red cells aggregate and, if so, would form the basis of a diagnostic test. The subsequent series of experiments, including those using cells from infants with haemolytic disease of the newborn were spectacularly successful and the key descriptions of the method and their application to various diseases appeared in The Lancet and the British Journal of Experimental Pathology in 1945 and 1946. Within a few years the ‘anti-globulin’ or ‘Coombs test’ was adopted by virtually every haematology laboratory and blood transfusion service throughout the world and remains a ‘gold standard’.
Robin Coombs had a huge impact on British immunology and was one of those responsible for setting up the British Society for Immunology in the 1950s. His seminal textbook Clinical aspects of immunology (Oxford, Blackwell Scientific Publications, 1963), co-edited with Philip Gell, contained the famous ‘classification of allergic reactions’. The classification brought clarity to the general field of tissue injury caused by hypersensitivity reactions which had hitherto been confused and bedevilled with muddled terminology. The Cambridge school of the 1960s and 1970s, under Coombs leadership, brought together clinicians and scientists from seemingly unrelated areas such as asthma and allergy, transplantation surgery, rheumatology and auto-immunity, who found a common language for exchanging ideas on disease mechanisms. Robin Coombs was an inspirational teacher and those fortunate enough to come under his influence were deeply affected by his infectious enthusiasm, as well as his kindness and consideration for his many graduate students.
In the later part of his career Robin Coombs tirelessly pursued his ‘milk-anaphylaxia’ hypothesis of cot death, based largely on observations in the guinea pig. He believed that many cases of the sudden infant death syndrome were due to allergy to cow’s milk which babies had aspirated into their lungs when sleeping. The theory was not widely accepted and difficult to prove.
Robin Coombs was born in London and educated in South Africa and Edinburgh, where he graduated in veterinary medicine. He went to Cambridge in 1944 as a PhD student, where he remained for all of his life, mostly in the department of pathology. He married his first graduate student, Anne Blomfield. After a succession of academic posts Robin Coombs became the Quick professor of biology in 1966 and was a fellow of Corpus Christi College and the first warden of Leckhampton College. He received honorary degrees from the universities of Guelph, Netherlands and Edinburgh, and was elected a fellow of the Royal Society in 1965.
Robin Coombs was one of the last ‘all-round’ immunologists. He had an immense breadth of knowledge of the field and was devoted to laboratory work. With basically simple techniques, mostly, red cell agglutination and the red cell ‘rosette assay’, he addressed a host of problems in allergy, auto-immunity and infection. He demonstrated admirably that imagination is more important than high technology. Working with Robin Coombs was fun and enormously rewarding. His contribution to health and learning was outstanding.
A B Kay
[Brit.med.J.,2006,332,1514; The Independent 6 March 2006; The Times 6 March 2006; The Guardian 8 March 2006; The Daily Telegraph 30 March 2006]