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Anemia, Autoimmune Hemolytic

Rahul Banerjee, MD and Heather J. Hue, MD, MPH Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Autoimmune hemolytic anemia (AIHA): increased destruction of red blood cells (RBC) mediated by autoantibodies against RBC surface antigens (1,2)

  • Classified into three main groups (1,2...

DIAGNOSIS

HISTORY

  • Symptoms of anemia: fatigue/weakness, palpitations, dyspnea, dizziness (1,2,3)[C]

  • Symptoms of hemolysis: jaundice (± dark urine in intravascular hemolysis, e.g., PCH) (1,2,3)[C]

  • Tempera...

TREATMENT

GENERAL MEASURES

  • Treatment of underlying condition if identified (1,2,3)[C]

  • Avoidance of triggering agent (1)[C]

    • Cold weather, cold IV fluids for cold AIHA

    • Offending medication if drug-induced

  • Vi...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Serial Hgb measurements to evaluate degree of anemia and/or ongoing hemolysis (1,2,3)[C]

  • Avoidance of hypothermic fluids, blood products, or surg...

REFERENCES

1
Go RS, Winters JL, Kay NE. How I treat autoimmune hemolytic anemia. Blood.  2017;129(22):2971–2979. {L-End} [View Abstract on OvidMedline]
2
Hendrickson JE, Tormey CA. Red blood cell a...

ADDITIONAL READING

  • Khan U, Ali F, Khurram MS, et al. Immunotherapy-associated autoimmune hemolytic anemia. J Immunother Cancer.  2017;5:15.

  • Mauro FR, Coluzzi S, Paoloni F, et al. Clinical characte...

SEE ALSO

  • Leukemia, Chronic Lymphocytic; Lupus Erythematosus, Systemic (SLE)

  • Algorithm: Anemia

CODES

ICD10

  • D59.1 Other autoimmune hemolytic anemias

  • D59.0 Drug-induced autoimmune hemolytic anemia

ICD9

283.0 Autoimmune hemolytic anemias 

SNOMED

  • 413603009 Autoimmune hemolytic anemia (disorder)

  • 309742004 ...

CLINICAL PEARLS

  • AIHA is a rare cause of anemia, generally diagnosed with a positive DAT assay (Coombs).

  • In AIHA secondary to an underlying process (e.g., CLL, SLE, EBV, Mycoplasma), treatment of the un...

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