Autoimmune haemolytic anaemia

In this form of haemolytic anaemia antibodies are formed against red cell antigens resulting in premature destruction of cells. (1)

Cold haemagglutin disease is a reactive autoimmune haemolytic associated with IgM antibodies to red blood cells. These antibodies react best at low temperature.

• majority of cases are idiopathic and present in patients over the age of 60 years

Warm reactive autoimmune haemolytic anaemias are associated with IgG antibodies to red blood cells

• these antibodies react best at body temperature
• 50% of cases are idiopathic
• of the known causes, the most common associations are with lymphoid neoplasms, such as chronic lymphoid leukaemia, or autoimmune disease, such as systemic lupus erythematosus.

Evidence suggests the combination of rituximab plus glucocorticoid (GC) may increase the rate of complete haematological response over GC monotherapy in newly diagnosed warm autoimmune haemolytic anaemia (2)

Reference:

1. Michalak S et al. Autoimmune hemolytic anemia: current knowledge and perspectives. Immun Ageing. 2020 Nov 20;17(1):38.
2. Liu A-yP, Cheuk DKL. Disease-modifying treatments for primary autoimmune haemolytic anaemia. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012493. DOI: 10.1002/14651858.CD012493.pub2.