What Is Autoimmune Haemolytic Anemia?: Treatment, Symptoms & Types

Depending on the reactivity to the temperature with which the antibodies bind to the red blood cells, it is possible to distinguish hemolytic anemia from hot autoantibodies (in which the antibodies are active at a temperature equal to or higher than 37° C), disease from cold antibodies (the reaction occurs at lower temperatures) and mixed forms.

• L’hemolytic anemia due to warm autoantibodies it is the most widespread form of autoimmune hemolytic anemia; this disease can occur spontaneously (idiopathic or primary) or in association with some pathologies (including lymphoma, chronic lymphocytic leukemia, SLE and other autoimmune diseases). For the most part, auto-antibodies are IgG with limited specificity; hemolysis occurs mainly in the spleen.
• Me too’ cold autoantibody anemia it can be idiopathic (primary) in nature or secondary to lymphoproliferative syndromes and infections (especially mycoplasma pneumonia or mononucleosis). Infections tend to give rise to an acute disease, while idiopathic forms tend to become chronic. The antibodies are generally IgM and hemolysis occurs mainly in the extravascular system of mononuclear phagocytes of the liver. Cold autoantibody anemia includes cold agglutinin disease and paroxysmal cold hemoglobinuria.

An immunologically mediated erythrocyte lysis can also occur due to the intervention of alloantibodies in the hemolytic transfusion reaction (following a blood transfusion from an incompatible donor) and in hemolytic disease of the newborn.

Finally, there are cases (about 10%) on an immunological basis that can be related to the previous one taking a drug. The mechanisms by which these drugs damage erythrocytes and induce hemolysis can be different (some drugs stimulate the production of autoantibodies directed against Rh antigens; others bind to the red blood cell membrane, temporarily acting as haptens). Possible drugs that can cause hemolytic anemia include a-methyldopa, levodopa, high-dose penicillin, cephalosporins, quinidine, and sulfonamides.

In cold autoantibody disease, other signs secondary to prolonged exposure to cold may be present, such as acrocyanosis, Raynaud’s syndrome, or ischemic incidents associated with low temperatures.

The diagnosis is based on clinical or laboratory evidence of hemolysis. Treatment depends on the specific cause; Possible approaches include corticosteroids, IV immunoglobulins, use of immunosuppressants, and splenectomy. In drug-induced cases, stopping the administration of the causative agent may be considered to achieve remission of the disease.