Autoimmune

Hemolytic
Anemia

Jess Hill, Nathanael Leftwich, Alex Snider,

Taylor Tranchida, & Allison Thelen
Prevalence/Incidence
Prevalence:
● All ages and genders are at risk for AIHA but women are at a higher risk for autoimmune
diseases than men
● wAIHA is the most common and account for about ⅔ of cases
● Cold is the second most common and occurs most often in people over the age of 50
● PCH typically occurs in children and is rare in adults
Incidence:
● Incidence is 1.77 cases per 100,000 per year
Prevention:
● Can’t prevent AIHA, but doctors can monitor people who have a viral infection or who use
certain medications, to ensure that AIHA doesn’t develop
Transmission
Transmission:
● Inherited: Parents pass the gene for the condition to their children
○ Two common causes of this anemia are sickle cell anemia and thalassemia
● Acquired: Can develop the condition later
○ The body makes normal cells but they are later destroyed
○ It May happen because of:
■ Viral infection
■ Meds
■ SLE
■ Blood cancers
■ Overactive spleen
○ Some may be chronic or temporary
Etiology
Warm Causes: Cold Causes:
- Idiopathic - Dependent upon presentation
- Children - viral infections are a common precipitant - Chronic disease:
- SLE - Leukemia
- Lymphomas - Lymphomas
- Leukemia - Acute:
- Beta-lactam antibiotics - Viral pneumonia
- Penicillin - Mycoplasma
- Cephalosporins - Infectious mononucleosis
Pathology
● Destruction of RBCs intravascularly or extravascularly (spleen)
● Two common types:
○ Warm AIHA:
■ More common and occurs in warmer temperatures (37 degrees C)
■ IgG antibodies and RBCs are removed in the spleen.
○ Cold AIHA:
■ Less common and occurs in colder temperatures
■ IgM antibodies interact with polysaccharide antigens . Lysis by the complement system
and intravascular hemolysis
● Nutrient deficiency
○ Iron
○ Vitamin B12
○ Folate
○ Formation of hemoglobin + RBCs
Signs and Symptoms

● Mild AIHA may only include symptoms such as fatigue.

● As it progresses, the signs and symptoms may include:
○ Weakness
○ Dyspnea on exertion
○ Easy fatigue
○ Pallor
○ Tachycardia
○ Increased angina in people with preexisting heart disease
○ Occasionally, koilonychia
● Fever, chills, jaundice (build up of bilirubin) and dark urine may also be symptoms of
AIHA.
Diagnosis and Treatment
● Diagnosis for AIHA is made by blood tests
○ Complete Blood Count
○ Peripheral Smear
○ Reticulocyte count
○ Elevated bilirubin and lactate dehydrogenase
○ Decreased haptoglobin
○ A positive Coombs test
● Medical Treatment
○ Treatment is directed at relieving the patient’s symptoms
○ For the correct type of treatment to be given, the underlying cause has to be known
○ Cold AIHA- typical treatment requires only a warm environment, in severe cases you
would have plasmapheresis
○ Warm AIHA- typical treatment is corticosteroids and immunosuppressive
medications
Prognosis
● Usually great survival rates
● Greater variance based on type
○ Warm AIHA
■ Primary 9.8 years
■ Secondary 3.3 years
○ CAD
■ 8.8 years
● Causes of death
○ Anemia
○ Infection
○ Cardiovascular
○ Cancer
○ Bleeding
Implications and Considerations for Physical Therapy

● tolerance for exercise

● Poor healing and bruising
● Progress exercise slowly
● Upper left quadrant
● Mobility issues
● Refer if necessary
Clinical Pearls
Signs and Symptoms: fatigue, SOB, pallor, tachycardia, dark urine,
chills
Treatment: corticosteroids, immunosuppressant medications for
warm AIHA
Review Questions

Autoimmune Hemolytic What are the two main

anemia is characterized by types of Autoimmune
the destruction of what Hemolytic anemia?
type of cells?

Red Blood Cells Warm AIHA and Cold

Agglutinin Disease (CAD)
Resources
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Goodman, C. C., & Fuller, K. S. (2015). Disorders of Erythrocytes. In Pathology: Implications for the physical therapist (Fourth Edition, pp.
714–718). essay, Saunders Elsevier.

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Ronald S. Go, Jeffrey L. Winters, Neil E. Kay; How I treat autoimmune hemolytic anemia. Blood 2017; 129 (22): 2971–2979.

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