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Immune hemolytic anemia

Anemia - immune hemolytic; Autoimmune hemolytic anemia (AIHA)

 

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to the body's tissues.

Red blood cells last for about 120 days before the body gets rid of them. In hemolytic anemia, red blood cells in the blood are destroyed earlier than normal.

Immune hemolytic anemia occurs when antibodies form against the body's own red blood cells and destroy them. This happens because the immune system mistakenly recognizes these blood cells as foreign.

Causes

 

Possible causes include:

  • Certain chemicals, drugs, and toxins
  • Infections
  • Transfusion of blood from a donor with a blood type that does not match
  • Certain cancers

When antibodies form against red blood cells for no reason, the condition is called idiopathic autoimmune hemolytic anemia .

The antibodies may also be caused by:

  • Complication of another disease
  • Past blood transfusions
  • Pregnancy (if the baby's blood type is different from the mother's)

Risk factors are related to the causes.

 

Symptoms

 

You may not have symptoms if the anemia is mild. If the problem develops slowly, symptoms that may occur first include:

  • Feeling weak or tired more often than usual, or with exercise
  • Headaches
  • Problems concentrating or thinking

If the anemia gets worse, symptoms may include:

  • Lightheadedness when you stand up
  • Pale skin color ( pallor )
  • Shortness of breath
  • Sore tongue

 

Exams and Tests

 

You may need the following tests:

  • Absolute reticulocyte count
  • Direct or indirect Coombs test
  • Hemoglobin in the urine
  • LDH (level of this enzyme rises as a result of tissue damage)
  • Red blood cell count (RBC), hemoglobin, and hematocrit
  • Serum bilirubin level
  • Serum free hemoglobin
  • Serum haptoglobin
  • Donath-Landsteiner test
  • Cold agglutinins
  • Free hemoglobin in the serum or urine
  • Hemosiderin in the urine
  • Platelet count
  • Protein electrophoresis - serum
  • Pyruvate kinase
  • Serum haptoglobin level
  • Urine and fecal urobilinogen

 

Treatment

 

The first treatment tried is most often a steroid medicine, such as prednisone. If steroid medicine do not improve the condition, treatment with intravenous immunoglobulin (IVIG) or removal of the spleen (splenectomy) may be considered.

You may receive treatment to suppress your immune system if you do not respond to steroids. Drugs such as azathioprine (Imuran), cyclophosphamide (Cytoxan), and rituximab (Rituxan) have been used.

Blood transfusions are given with caution, because the blood may not be compatible and it may cause more red blood cell destruction.

 

Outlook (Prognosis)

 

The disease may start quickly and be very serious, or it may stay mild and not need special treatment.

In most people, steroids or splenectomy can totally or partially control anemia.

 

Possible Complications

 

Severe anemia rarely leads to death. Severe infection may occur as a complication of treatment with steroids, other medicines that suppress the immune system, or splenectomy. These treatments impair the body's ability to fight infection.

 

When to Contact a Medical Professional

 

Call your health care provider if you have unexplained fatigue or chest pain, or signs of infection.

 

Prevention

 

Screening for antibodies in donated blood and in the recipient may prevent hemolytic anemia related to blood transfusions.

 

 

Open References

References

Jager U, Lechner K. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice . 6th ed. Philadelphia, PA: Elsevier; 2013:chap 44.

Michel M. Autoimmune and intravascular hemolytic anemias. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 160.

 
  • Antibodies

    Antibodies - illustration

    Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

    Antibodies

    illustration

    • Antibodies

      Antibodies - illustration

      Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

      Antibodies

      illustration

    A Closer Look

     

    Self Care

     

      Tests for Immune hemolytic anemia

       
       

      Review Date: 2/1/2016

      Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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