Difficult Cases of Autoimmune Hemolytic Anemia : A Challenge for the Internal Medicine Specialist

Autoimmune hemolytic anemia (AIHA) is diagnosed in the presence of anemia, hemolysis, and direct antiglobulin test (DAT) positivity with monospecific antisera. Many confounders of anemia and hemolytic markers should be included in the initial workup (i.e., nutrients deficiencies, chronic liver or kidney diseases, infections, and cancers). Besides classical presentation, there are difficult cases that may challenge the treating physician. These include DAT negative AIHA, diagnosed after the exclusion of other causes of hemolysis, and supported by the response to steroids, and secondary cases (infections, drugs, lymphoproliferative disorders, immunodeficiencies, etc.) that should be suspected and investigated through careful anamnesis physical examination, and specific tests in selected cases. The latter include autoantibody screening in patients with signs/symptoms of systemic autoimmune diseases, immunoglobulins (Ig) levels in case of frequent infections or suspected immunodeficiency, and ultrasound/ computed tomography (CT) studies and bone marrow evaluation to exclude hematologic diseases. AIHA occurring in pregnancy is a specific situation, usually manageable with steroids and intravenous (iv) Ig, although refractory cases have been described. Finally, AIHA may complicate specific clinical settings, including intensive care unit (ICU) admission, reticulocytopenia, treatment with novel anti-cancer drugs, and transplant. These cases are often severe, more frequently DAT negative, and require multiple treatments in a short time.

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:9

Enthalten in:

Journal of clinical medicine - 9(2020), 12 vom: 27. Nov.

Sprache:

Englisch

Beteiligte Personen:

Fattizzo, Bruno [VerfasserIn]
Giannotta, Juri Alessandro [VerfasserIn]
Serpenti, Fabio [VerfasserIn]
Barcellini, Wilma [VerfasserIn]

Links:

Volltext

Themen:

Cold agglutinin disease
Immunodeficiencies
Intensive care unit
Journal Article
Review
Transplant
Warm autoimmune hemolytic anemia

Anmerkungen:

Date Revised 26.12.2020

published: Electronic

Citation Status PubMed-not-MEDLINE

doi:

10.3390/jcm9123858

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM318273217