What is Autoimmune Hemolytic Anemia: Causes, Symptoms, Treatment, Diagnosis

Autoimmune Hemolytic Anemia is an autoimmune disorder in which the body starts producing antibodies that attack the red blood cells and destroy it making the person anemic. Some cases of Autoimmune Hemolytic Anemia are completely asymptomatic while some people with this condition complain of feeling fatigued, short of breath, and are quite pale. In severe circumstances, Autoimmune Hemolytic Anemia even causes jaundice as it enlarges the spleen. A comprehensive blood test is the best way to diagnose Autoimmune Hemolytic Anemia and corticosteroids and immune suppressants are the frontline treatment for this condition.^[1,2]

The destruction of the red blood cells in Autoimmune Hemolytic Anemia can be acute or chronic. This means that the antibodies can either start destroying the red blood cells suddenly or this phenomenon may occur over a period of time. In cases where Autoimmune Hemolytic Anemia is caused by a virus, once the infection clears the destruction of the red blood cells stop and normalization of the levels occurs.^[1,2]

Coming to the classification of Autoimmune Hemolytic Anemia, it is basically classified as warm and cold as well as primary and secondary.

Warm Autoimmune Hemolytic Anemia occurs when the IgG antibodies start destructing the red blood cells. These antibodies attach to the red blood cells at normal body temperature. More than 90% of cases of Autoimmune Hemolytic Anemia are of this type only.^[1,2]

The symptoms of this form of Autoimmune Hemolytic Anemia mostly occurs over a period of time ranging from days to even months; however, some cases of acute onset warm type Autoimmune Hemolytic Anemia have also been observed. The primary symptoms of this type of Autoimmune Hemolytic Anemia include jaundiced skin, fatigue, dizziness and palpitations.^[1,2]

Cold Autoimmune Hemolytic Anemia occurs when the IgM antibodies are involved in the destruction of red blood cells. This occurs in cold temperatures and account for about 20% of the cases of Autoimmune Hemolytic Anemia. The symptoms will be triggered when the person will be exposed to cold climate or a viral infection.^[1,2]

These symptoms include dizziness and fatigue, yellowing of skin, hands and feet feeling cold, chest pain, diarrhea and vomiting, and bluish discoloration of the skin in the hands and feet.^[1,2]

Primary Autoimmune Hemolytic Anemia occurs when there is no sign of any other medical problems while secondary Autoimmune Hemolytic Anemia occurs as a result of another medical condition. Some of the medical conditions that can cause Autoimmune Hemolytic Anemia include RA, SLE, ulcerative colitis, thyroid disorders, chronic kidney disease, and other immune disorders. Some viral infections that trigger the symptoms of Autoimmune Hemolytic Anemia include EBV virus, measles, mumps, HIV and hepatitis.^[2]

To understand what causes Autoimmune Hemolytic Anemia, it is important to know a little bit about where the RBCs are formed. It is the bone marrow that produces the red blood cells, the white blood cells, and the platelets. The function of the white blood cells is to fight off infections. Platelets help in blood clotting. The red blood cells transport oxygen through the blood throughout the body. White blood cells produce antibodies which help in fighting off infections.^[2]

In cases of Autoimmune Hemolytic Anemia these white blood cells start producing antibodies that attach themselves to the red blood cells and start destroying it causing the person to have anemia. There are several reasons for this to happen. Some people get it as a result of exposure to certain toxins or chemicals in the form of medications.^[2]

A complicated infection can also cause Autoimmune Hemolytic Anemia. A mismatched blood transfusion is also one of the causes of Autoimmune Hemolytic Anemia. There are some cases where a female develops Autoimmune Hemolytic Anemia if the blood group of the fetus does not match with that of the mother. There are also certain types of cancer that result in a person having Autoimmune Hemolytic Anemia.^[2]

Primary symptoms of Autoimmune Hemolytic Anemia include slight fever, fatigue, problems with focusing and concentrating, being pale, tachycardia, problems breathing, jaundice, pain in the muscles and joints, frequent bout of headaches, nausea, vomiting and diarrhea. Some people also complain of giddiness or dizziness when they stand up from a sitting position.^[2]

The best way to diagnose Autoimmune Hemolytic Anemia is through a blood test. This will be done once a physician suspects anemia as a cause of the patient’s symptoms. A person with Autoimmune Hemolytic Anemia will have increased count of immature red blood cells also called reticulocytes on analysis of the blood. A blood smear will show rapid destruction of red blood cells. The blood test will also show an increase in the levels of bilirubin which is produced as a result of destruction of red blood cells with a decrease in the levels of a protein called haptoglobin. The function of haptoglobin is to bind the hemoglobin that is released due to destruction of red blood cells.^[1,2]

In Autoimmune Hemolytic Anemia, there are also some antibodies that attach themselves to the red blood cells leading to their destruction. This can be found out by conducting a direct antiglobulin or a Coombs test. There are also certain tests that help in determining the cause of the autoimmune reaction responsible for rapid red blood cell destruction.^[1,2]

The treatment for Autoimmune Hemolytic Anemia depends on certain factors. In cases where the condition is mild, there is no specific treatment required and the condition resolves with time. This happens in almost 70% of all cases of Autoimmune Hemolytic Anemia. However, there are cases where treatment is required. This can be done by way of medication, transfusion, or even surgery. The requirement for treatment is based on the age of the patient and overall health status. The past medical history also plays an important part.^[1,2]

The severity of anemia is also a critical factor in determining the treatment for this condition. If another underlying medical condition such as infection, use of certain medications or cancer is responsible for Autoimmune Hemolytic Anemia then treating the primary source is the main focus of managing the condition and controlling the symptoms.^[1,2]

Corticosteroids are prescribed to suppress the immune system in people with Autoimmune Hemolytic Anemia. This is the frontline treatment for this condition. The medication has been found to be extremely efficacious in controlling the symptoms of Autoimmune Hemolytic Anemia. If the condition is so severe that corticosteroids are deemed ineffective then alternative medications are given to suppress the immune system. This is what is termed as immunosuppressive therapy. These medications prevent the immune cells from attacking the bone marrow and destroying the red blood cells. This helps in increasing the blood count levels in the body.^[1,2]

However, there may be some adverse effects of this therapy and all the pros and cons should be thoroughly discussed with the physician before starting any treatment.

Surgery is generally done when all forms of conservative treatments do not yield favorable results. The surgery involves complete removal of the spleen.^[2]

It is the spleen that removes all the abnormal red blood cells. Once removed these red blood cells are preserved thus preventing anemia. Blood Transfusion is done in severe cases where the blood count is abnormally low and treatments are not effective.^[2]

In conclusion, Autoimmune Hemolytic Anemia is an autoimmune disorder where the immune system mistakenly attacks the red blood cells thereby destroying it resulting in anemia. It is basically caused when the white blood cells start producing antibodies that attach themselves to the red blood cells and destroy it.^[1,2]

Autoimmune Hemolytic Anemia is generally a self-limiting condition and in 70% of cases goes way without any treatment. However, in some cases, people do need medications in the form of corticosteroids or immunosuppressive therapy to calm down the symptoms. Surgery is at times required which involves removal of spleen to preserve red blood cells.^[1,2]

The overall prognosis of Autoimmune Hemolytic Anemia is quite good with it being a self-limiting condition. In people in their early 20s or teenagers, Autoimmune Hemolytic Anemia can be a long term condition and will require frequent treatments and monitoring to control the symptoms of Autoimmune Hemolytic Anemia.^[1,2]

References: