AUTOIMMUNEHEMOLYTIC ANEMIA

• One of the most common causes of acquired hemolytic anemia.

• Two types of antibodies are involved:

IgG (warm agglutinins)

IgM (cold agglutinins)

WARM AUTOIMMUNE HEMOLYTIC ANEMIA

Causes:

• Idiopathic: most frequently.• Viral infection: HIV & infectious mononucleosis• Patients with SLE, rheumatoid arthritis, Scleroderma,

Dermatomyositis & Ulcerative colitis.• Chronic lymphocytic leukemia & non-Hodgkin

lymphoma.• Drugs:

Clinical picture:

• Varies greatly with the amount and effectiveness of causative antibody ranging from no symptoms to life threating clinical syndrome.

• Clinical picture of underlying causes associated.

Complications

• Lymphoproliferative disorders: 18% of patients with Idiopathic AIHA.

• Venous thromboembolism: described in adults with Idiopathic AIHA, patients with underlying HIV, antiphospholipid and lupus anticoagulant +ve patients.

Lab. findings:

• Normocytic normochromic anemia

• Blood film: spherocytes• Increased serum LDH,

indirect hyperbilirubinemia• Reduced Haptoglobin.• Reitculocytosis.• +ve Direct coombs.• Thrombocytopenia (Evan’s

Syndrome)

Treatment:

COLD AUTOIMMUNE HEMOLYTIC ANEMIA

• Cold agglutinin disease typically characterized by the presence of IgM antibodies directed against RBC membrane.

• They are produced either in response to infection or by neoplastic growth of a single immunocyte clone.

Clinical manifestations

• Symptoms and signs of anemia.

• Changes on exposure to cold: Livedo reticularis and Acrocyanosis.

• Infection.

Lab. Findings:

• Presence of high titer of cold agglutinins.• +ve direct coombs.• Additional diagnosis of mycoplasma infection,

infectious mononucleosis or lymphoma.

Treatment

• Avoidance of cold.• Cytotoxic agents.• Rituximab.• Plasmapharesis.

Thank you