Professor Robin Coombs FRS (1921–2006)

It is with great sadness that Vox Sanguinus records the death of Professor Robin Coombs, an immunologist of great distinction who is principally known for the blood test that bears his name and for his classification of allergic reactions which has been used by clinicians, scientists and students worldwide for over 40 years. Virtually every clinician has heard of the Coombs’ test. It identifies incomplete antibodies in autoimmune haemolytic anaemia and is part of the standard cross-matching procedure used to prevent transfusion reactions caused by incompatible blood. It is also crucial in diagnosing haemolytic disease of the newborn. The story of the discovery of the Coombs test goes back to the early 1940s when the Rh blood groups were discovered by Landsteiner and Wiener. Rob Race and colleagues, working at that time at the Galton Laboratory Serum Unit at the Department of Pathology in Cambridge, realized that in addition to agglutinating anti-D, there was a variant, likely to be of clinical importance, known as ‘incomplete antibody’. Robin Coombs, a recently arrived graduate student, 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, the ‘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 red cell antibodies produced direct red cell agglutination. Coombs realized 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, and conducted with Mourant & Race, 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 ‘antiglobulin’ or Coombs’ test had been adopted by virtually every haematology laboratory and Blood Transfusion Service throughout the world and remains a ‘gold standard’. The test is the basis of the enzyme-linked immunosorbent assay (ELISA) and many other assays used in microbiology and other pathology disciplines. Robin Coombs had a huge impact on British immunology and was one of those responsible for setting up the British Society of Immunology in the 1950s. His seminal textbook, Clinical Aspects of Immunology, co-edited with Philip Gell and first published in 1963, contained the famous ‘Classification of Allergic Reactions’. The classification brought clarity to the general field of tissue injury caused by hypersensitivity reactions that had hitherto been confused and bedevilled with muddled terminology. The Cambridge school of the 1960s and 70s, under Coombs’ leadership, brought together clinicians and scientists from seemingly unrelated areas, such as asthma and allergy, transplantation surgery, rheumatology and autoimmunity, and who found a common language for exchanging ideas on disease mechanisms. Robin Coombs was an inspirational teacher, and those of us fortunate enough to come under his influence were deeply affected by his infectious enthusiasm as well as by his kindness and consideration for his many graduate students. In the latter part of his career, Robin Coombs tirelessly pursued his ‘milk-anaphylaxis’ hypothesis of cot death, developed with William Parish and later with Andrew Walls, which was based largely on observations in the guinea pig. He believed that many cases of the sudden infant death syndrome were caused by allergy to cow's milk, which babies had aspirated into their lungs when sleeping. The theory was not widely accepted and was difficult to prove. He remained disappointed with what he believed was a lack of interest and research in the area. Robert Royston Amos (‘Robin’) Coombs was born in 1921 in London and was educated in South Africa and Edinburgh, where he graduated in veterinary medicine. He came 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, the Netherlands and Edinburgh, and was elected a Fellow of the Royal Society in 1965. He died in Cambridge, after a long illness, on 25th January 2006, aged 85 years, and is survived by Anne, his son Robert and daughter Rosalind, and four grandchildren.

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