In primary WAIHA, there is only a low chance of spontaneous or drug-induced long-term remission or cure. Thus, the primary goal of treatment is to keep the patient clinically comfortable and to prevent “hemolytic crises” with the use of medical interventions with the lowest possible short- and long-term side effects.
Full Answer
What is a warm autoantibody?
Warm autoantibodies are antibodies that react with intrinsic antigens present on autologous red blood cells (RBCs) at body temperature. However, the relationship of an autoantibody and its hemolytic potential is not well defined, and some may never have a pathologic effect in the patient. Therefore, the presentation of patients
Is it a cold or a warm autoantibody?
Cold autoantibodies are targeted against “self” antigens on the red cell surface, and react best at temperatures well below body temperature (contrast to warm autoantibodies).Cold autoantibodies commonly target antigens in the I system (I or i), and they are really, really, REALLY common!
What is a warm antibody?
Where to Start
- The Merck Manuals Online Medical Library provides information on this condition for patients and caregivers.
- The National Heart, Lung, and Blood Institute (NHLBI) has information on this topic. ...
- The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. ...
What are the signs and symptoms of hemolytic anemia?
You might get one of these:
- Reticulocyte count. This measures the number of young red blood cells in your body. ...
- Coombs' test. The doctor will do this test to see if your body is making antibodies against red blood cells.
- Peripheral smear. ...
- Bilirubin test. ...
- Haptoglobin test. ...
- Cold agglutinin titer. ...
How do you treat warm autoimmune haemolytic anemia?
The treatment of warm antibody hemolytic anemia is symptomatic and supportive. Affected individuals are usually treated with corticosteroid drugs such as prednisone and can usually be well controlled with proper treatment.
What is the primary treatment for IMHA?
The cornerstone of treatment for IMHA is immunosuppressive therapy. Immunosuppression is usually accomplished with glucocorticoids, with the addition of a second immunosuppressive agent, if needed.
What are the goals of pharmacotherapy for this patient's anemia?
The goals of pharmacotherapy are to reduce morbidity and to prevent complications in patients with hemolytic anemia. Treatment is specific to the type of hemolytic anemia.
What medication is used for hemolytic anemia?
Glucocorticoids, such as prednisone, are usually the first line of treatment in autoimmune hemolytic anemia (AIHA).
Which of the following is most appropriate for initial treatment of canine immune mediated hemolytic anemia?
Mycophenolate mofetil has been anecdotally reported to be effective in treating a variety of immune-mediated diseases in dogs, including myasthenia gravis. 26 The recommended starting oral dose of mycophenolate mofetil is 20 to 40 mg/kg/day divided into two or three doses.
How do you treat autoimmune hemolytic anemia in dogs?
In some cases of idiopathic AIHA, the dog will respond rapidly to treatment with immunosuppressive doses of corticosteroids (usually prednisone). In other cases, a combination of immunosuppressive medications, such as azathioprine or cyclosporine, may be needed to try to get the condition under control.
What are goals of anemia?
The goal of treatment is to increase the amount of oxygen that your blood can carry. This is done by raising the red blood cell count and/or hemoglobin level. (Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body.) Another goal is to treat the underlying cause of the anemia.
What is good for anemia?
Beans. Dark green leafy vegetables, such as spinach. Dried fruit, such as raisins and apricots. Iron-fortified cereals, breads and pastas.
What is the first line treatment for iron-deficiency anemia?
The current first line of therapy for patients with iron deficiency anemia is oral iron supplementation. Oral supplementation is cheap, safe, and effective at correcting iron deficiency anemia; however, it is not tolerated by some patients and in a subset of patients it is insufficient.
What is warm autoimmune hemolytic anemia?
Warm autoimmune hemolytic anemia (wAIHA) is caused by increased erythrocyte destruction by immunoglobulin G (IgG) autoantibodies, with or without complement activation. Antibody-dependent cell-mediated cytotoxicity by macrophages/activated lymphocytes occurs in the lymphoid organs and spleen (extravascular hemolysis).
What is autoimmune haemolytic Anaemia?
What is autoimmune haemolytic anaemia? Autoimmune haemolytic anaemia is a rare blood condition. It occurs when the immune system (which normally defends the body against infection) makes an antibody against its own red blood cells. This causes break down of the red blood cells called haemolysis.
What is autoimmune hemolytic anemia?
Autoimmune hemolytic anemia (AIHA) occurs when your immune system makes antibodies that attack your red blood cells. This causes a drop in the number of red blood cells, leading to hemolytic anemia.
Overview
Autoimmune hemolytic anemia (AIHA) occurs when your immune system mistakes red blood cells as unwanted substances. As a result, your body produces antibodies that destroy red blood cells, which can lead to a low amount of red blood cells (known as anemia ).
Diagnosis and Tests
Your healthcare provider will recommend a complete blood count (CBC) to look for warning signs of anemia. Specifically, this test measures:
Management and Treatment
Autoimmune hemolytic anemia treatment usually involves addressing underlying conditions first. For example, if your AIHA is linked to lupus, then your healthcare provider will probably start by treating the lupus directly. If AIHA is caused by lymphoma, treating the lymphoma directly is important.
Prevention
It’s not always possible to prevent autoimmune hemolytic anemia. But if you have a viral infection or use medications that are commonly linked to AIHA, then your healthcare provider can monitor your situation in an effort to reduce your risk of developing the condition.
Living With
If you start showing anemia symptoms — such as fatigue, weakness, jaundice or shortness of breath — schedule an appointment with your healthcare provider right away.
What causes autoimmune hemolytic anemia?
Warm autoimmune hemolytic anemia (wAIHA) is caused by increased erythrocyte destruction by immunoglobulin G (IgG) autoantibodies, with or without complement activation. Antibody-dependent cell-mediated cytotoxicity by macrophages/activated lymphocytes occurs in the lymphoid organs and spleen (extravascular hemolysis). The ability of the bone marrow (BM) to compensate determines clinical severity. The different pathogenic mechanisms, their complex interplay, and changes over time may explain wAIHA’s great clinical heterogeneity and unpredictable course. The disease may be primary, drug induced, or associated with lymphoproliferative neoplasms, autoimmune and infectious diseases, immunodeficiencies, solid tumors, or transplants. Therapeutic interventions include steroids, splenectomy, immunosuppressants, and rituximab; the latter is increasingly used in steroid-refractory cases based on evidence from the literature and a few prospective trials. We present 5 patient case studies highlighting important issues: (1) the diagnosis and proper use of steroid therapy, (2) the concerns about the choice between rituximab and splenectomy in second-line treatment, (3) the need of periodical re-evaluation of the disease to assess the possible evolution of relapsed/refractory cases in myelodysplastic and BM failure syndromes, and (4) the difficulties in managing cases of severe/acute disease that are at high risk of relapse. Incorporating novel targeted therapies into clinical practice will be an exciting challenge in the future.
What is the diagnostic algorithm for AIHA?
Diagnostic algorithm of AIHA. The DAT or Coombs test is the cornerstone of diagnosis, and allows the distinction of the different forms of AIHA. wAIHA is the most common form, accounting for 60% to 70% of all cases; the DAT is positive with anti-IgG antisera (70% of all wAIHA) or anti-IgG plus C at low titer. Cold agglutinin disease (CAD; 20% to 25% of all AIHAs) is characterized by DAT positivity with anti-C antisera and high titer of cold agglutinins. In mixed forms (5% to 10% of all AIHAs), the DAT is positive for IgG plus C, and cold agglutinins are present at high titer. The atypical forms (∼10% of all AIHAs) include DAT −, IgA, and warm IgM-driven AIHAs. Finally, it is necessary to record the very rare form named paroxysmal cold hemoglobinuria (1% to 3% of all AIHAs) sustained by the biphasic Donath-Landsteiner hemolysin. ELISA, enzyme-linked immunosorbent assay; LISS, low-ionic salt solution; MS-DAT, mitogen-stimulated DAT; PEG, polyethylene glycol; PNH, paroxysmal nocturnal hemoglobinuria.