Autoimmune Hemolytic Anemia

The term 'Autoimmune hemolytic anemia' refers to a group of blood disorders in which the immune system produces antibodies that attack the body's own red blood cells as if they are alien tissues.   The production of these 'auto-antibodies' is triggered by a malfunction of the body's immune system. Autoimmune hemolytic anemia is not a very common ailment and can occur at any age. Statistics reveal that autoimmune hemolytic anemia affects more women than men.

The exact cause of autoimmune hemolytic anemia cannot be conclusively established in about 50 % of the cases and this is referred to as idiopathic autoimmune hemolytic anemia. In a number of other cases, the condition can be traced to another disease like lupus or, in rare cases, due to the use of penicillin.

The destruction of the red blood cells by the auto-antibodies, characteristic of autoimmune hemolytic anemia, may take place suddenly and in a very short period of time but in other cases, it develops gradually. It has been observed by researchers working in this field that the destruction of red blood cells may stop after a period in some patients whereas in others, it persists and may even become chronic autoimmune hemolytic anemia.

Autoimmune Hemolytic Anemia

Autoimmune hemolytic anemia may be broadly divided into two types:

• Warm Autoimmune Hemolytic Anemia - In warm autoimmune hemolytic anemia, the auto-antibodies attach themselves to the host body's red blood cells at a temperature equal to the body temperature or higher. After attachment, they proceed to destroy the red blood cells.

• Cold Autoimmune Hemolytic Anemia - In cold autoimmune hemolytic anemia, the auto-antibodies attach themselves and destroy the red blood cells at temperatures that are well below the body's normal temperature.
  

Symptoms of Autoimmune Hemolytic Anemia     
People who have a gradual destruction of red blood cells due to autoimmune hemolytic anemia often show no symptoms especially if the quantity of red blood cells destroyed is small. In cases where the destruction is more severe or is faster, the symptoms exhibited are the same as those of other forms of anemia though mild jaundice may develop in addition. If the red blood cell destruction goes on for a few months or more, there may be spleen enlargement which manifests itself as a sense of fullness in the abdomen or, sometimes, even discomfort. It has been observed that when the autoimmune hemolytic anemia is caused by another disease the symptoms attributable to the disease will dominate, thus effectively masking the symptoms of this condition.

The presence of autoimmune hemolytic anemia is indicated if:

Anemia has already been diagnosed and blood examinations show a larger proportion of reticulocytes (immamture red blood cells) or
Anemia has already been diagnosed and increased bilirubin measurements occur or
Anemia has already been diagnosed and tests detect depressed levels of haptoglobin (a protein found in the blood).
Blood tests show an increase in the amount of specific antibodies. These antibodies may be attached to red blood cells and are detected and measured by the direct Coombs test. In some cases the antibodies are found in the the liquid portion of the blood and are detected and measured by the indirect Coombs test.

Treatment of Autoimmune Hemolytic Anemia

In case of mild symptoms of autoimmune hemolytic anemia, usually no treatment is necessary but if the red blood cell destruction is becoming severe, a corticisteroid (like prednisone) is usually prescribed with the treatment regime using high doses in the beginning and then decreasing the dosage gradually as the disease weakens. In case the patient does   not respond to the steroid or there are severe side effects, spleenectomy (surgical removal of the spleen) may have to be resorted to.