{"id":5270,"date":"2021-05-13T19:35:38","date_gmt":"2021-05-13T17:35:38","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/anemias\/hemolytic-anemias\/autoimmune-anemias\/"},"modified":"2022-02-07T15:23:14","modified_gmt":"2022-02-07T13:23:14","slug":"autoimmune-anemia","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/anemias\/hemolytic-anemias\/autoimmune-anemia\/","title":{"rendered":"Autoimmune hemolytic anemia (AIHA)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">In autoimmune hemolytic anemia (AIHA), antibodies are produced against components of RBCs. These antibodies can be of cold type (reacting with RBCs at low temperature, optimally at 4c; IgM) and warm type (reacting at 37c; IgG)<\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" id=\"classification-and-etiology\" class=\"wp-block-heading\" id=\"classification-and-etiology\" class=\"title_collection title1\">Classification and etiology<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">The classification is based on the etiology (primary\/secondary) and the antibody type (warm\/cold).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Warm type AIHA<\/strong><ul><li>Primary (idiopathic)<\/li><li>Secondary (most cases)<ul><li>Autoimmune<ul><li>Autoimmune diseases (SLE)<\/li><li>Lymphomas<\/li><li>Drug-induced (methyldopa)<\/li><\/ul><\/li><li>Alloimmune<ul><li>Hemolytic transfusion reactions (ABO-incompatible blood transfusion)<\/li><li>Hemolytic disease of the newborn (Rh-positive fetus to an Rh-negative mother)<\/li><li>Post-stem-cell grafting (antibodies produced by lymphocytes present in the graft)<\/li><li>Drug-induced (methyldopa)<\/li><\/ul><\/li><\/ul><\/li><\/ul><\/li><li><strong>Cold type AIHA<\/strong><ul><li>Primary<\/li><li>Secondary to infections (most cases)<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" id=\"warm-type-aiha\" class=\"wp-block-heading\" id=\"warm-type-aiha\" class=\"title_collection title1\">Warm type AIHA<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>IgG antibodies bind to the surface of RBCs, with or without complement (C3b)<\/li><li>They circulate through the spleen, where splenic macrophages bind to the antibodies through the Fc receptors<\/li><li>The macrophages remove the bound antibodies with parts of the RBC&#8217;s cell membrane, turning it into a sphere<\/li><li>The spherical cells are eventually destroyed in the <strong>spleen<\/strong>.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h3 class=\"wp-block-heading\" id=\"cold-type-aiha\" class=\"wp-block-heading\" id=\"cold-type-aiha\" class=\"title_collection title1\">Cold type AIHA<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>IgM antibodies bind to the surface of RBCs <strong>in peripheral tissues<\/strong> where the temperature is lower.<\/li><li>The antibodies are being shed off at higher temperatures as the RBCs travel through the body, leaving only the complement system attached; typically, the entire complement cascade is activated forming a MAC.<\/li><li>Hemolysis is mostly intravascular, and the RBCs are sequestrated by the <strong>liver<\/strong>.<\/li><li>Presents with chronic hemolysis worsening in cold weather, with purple discoloration of the skin at the tips of the extremities, nose, and ears.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h3 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title1\">Diagnosis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Complete blood count (showing anemia)<\/li><li>Chemistry (elevated unconjugated bilirubin and LDH, absent haptoglobin)<\/li><li>Blood smear (spherocytes in warm)<\/li><li>Direct Coombs test<ul><li>Warm type shows IgG<\/li><li>Cold type shows only the complement system (C3d)<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title1\">Treatment<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"warm-type-aiha\" class=\"wp-block-heading\" id=\"warm-type-aiha\" class=\"title_collection title2\">Warm type AIHA<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>If secondary, treat the cause<\/li><li><strong>Corticosteroids<\/strong><\/li><li>Cyclophosphamide<\/li><li>IVIG<\/li><li>Rituximab<\/li><li>Splenectomy in unresponsive patients<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" id=\"cold-type-iaha\" class=\"wp-block-heading\" id=\"cold-type-iaha\" class=\"title_collection title2\">Cold type IAHA<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Keep the patient warm<\/li><li>Cyclophosphamide<\/li><li>Rituximab<\/li><li><strong>Corticosteroids are not useful.<\/strong><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" id=\"classification-and-etiology\" class=\"wp-block-heading\" id=\"classification-and-etiology\">Classification and etiology<\/h3><h3 class=\"wp-block-heading\" id=\"warm-type-aiha\" class=\"wp-block-heading\" id=\"warm-type-aiha\">Warm type AIHA<\/h3><h3 class=\"wp-block-heading\" id=\"cold-type-aiha\" class=\"wp-block-heading\" id=\"cold-type-aiha\">Cold type AIHA<\/h3><h3 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h3><h3 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h3><h4 class=\"wp-block-heading\" id=\"warm-type-aiha\" class=\"wp-block-heading\" id=\"warm-type-aiha\">Warm type AIHA<\/h4><h4 class=\"wp-block-heading\" id=\"cold-type-iaha\" class=\"wp-block-heading\" id=\"cold-type-iaha\">Cold type IAHA<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>In autoimmune hemolytic anemia (AIHA), antibodies are produced against components of RBCs. These antibodies can be of cold type (reacting with RBCs at low temperature, optimally at 4c; IgM) and warm type (reacting at 37c; IgG) Classification and etiology The classification is based on the etiology (primary\/secondary) and the antibody type (warm\/cold). Warm type AIHA [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5264,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5270","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Autoimmune hemolytic anemia (AIHA) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/anemias\/hemolytic-anemias\/autoimmune-anemia\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/anemias\\\/hemolytic-anemias\\\/autoimmune-anemia\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/anemias\\\/hemolytic-anemias\\\/autoimmune-anemia\\\/\",\"name\":\"Autoimmune hemolytic anemia (AIHA) &#8211; 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