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Autoimmune Hemolytic Anemia: Types, Causes, Symptoms, Diagnosis, Treatment

Jun 22, 2023

Autoimmune Hemolytic Anemia: Types, Causes, Symptoms, Diagnosis, Treatment

The immunological condition known as autoimmune hemolytic anemia (AIHA) is very uncommon. In this condition, the body attacks red blood cells because it believes they are foreign objects, which leads to this disease. A blood transfusion is an uncommon kind of treatment, in addition to medication and surgery. Even while AIHA is very treatable, it can be devastating if ignored. so the patient should be treated right away.

Read this blog further to get a quick overview of this important topic for PATHOLOGY to ace your NEET PG exam preparation.

Types of Autoimmune Hemolytic Anemia

Warm autoimmune hemolytic anemia and cold autoimmune hemolytic anemia are the two main subtypes of this condition. The type of antibodies that are implicated in the disease determines this classification.

Warm Autoimmune Hemolytic Anemia 

Warm autoimmune hemolytic anemia is the most prevalent form of AIHA, which is caused by IgG antibodies, which bind red blood cells when the body temperature is normal. In most cases, symptoms develop gradually over several weeks. They can, however, sometimes appear within a few days.

Cold Autoimmune Hemolytic Anemia 

In this condition, IgM autoantibodies are involved in 10% to 20% of cases. When your blood is at lower temperatures than your body's core temperature, the antibodies bind red blood cells. The minimum temperature at which a cold autoantibody will bind varies widely.

Cold Autoimmune Hemolytic Anemia 

Symptoms of Autoimmune Hemolytic Anemia 

There are many similarities between the symptoms of AIHA and other types of anemia. You might have

  • Chills
  • Tachycardia
  • A pale complexion that may begin to yellow
  • Breathing difficulty
  • Fatigue and weakness
  • Chest discomfort
  • Jaundice
  • Dark feces
  • A spleen that is enlarged and causes an abdominal feeling of fullness

Depending on the sort of AIHA you have, several symptoms vary. Other symptoms of cold antibody hemolytic anemia include:

  • Chilly fingers and toes
  • Having bluish or reddish hands and feet
  • Headache
  • Digestion issues
  • Pain in both legs and back.

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Causes of Autoimmune Hemolytic Anemia 

Autoimmune diseases like lupus can cause autoimmune hemolytic anemia. Typically, our immune system produces proteins known as antibodies to kill foreign invaders like bacteria and viruses as soon as it detects them. When you have AIHA, your immune system produces antibodies that inadvertently target your own red blood cells for destruction.

Autoimmune hemolytic anemia can be brought on by several conditions and drugs. Here are a few of them:

  • Cancers like Chronic lymphocytic leukemia and non-Hodgkin's lymphoma 
  • Mycoplasma pneumonia-like infections
  • Methyldopa (Aldomet), quinine (Qualaquin), and sulfonamides, among other medications, including penicillin.
  • Viral strains include Epstein-Barr, CMV, HIV, and hepatitis

Diagnosis of Autoimmune Hemolytic Anemia 

A doctor will inquire about your symptoms and perform a physical checkup. To aid with the diagnosis, they may then conduct some blood and urine tests.

  • Through Complete Blood Count- The various components of blood are measured by the complete blood count (CBC). It comprises calculating the levels of hematocrit and hemoglobin.

A protein called hemoglobin transports oxygen throughout the body. Red blood cells' hematocrit value reveals how much room they occupy. Both can show signs of anemia in low doses.

  • Tests by Coombs- These blood examinations search for antibodies that might harm red blood cells.
  • Test of Reticulocytes- Reticulocytes, a subset of relatively immature red blood cells, are measured in this blood test. It can reveal if the bone marrow is producing red blood cells at a pace that is appropriate.If the body has low haemoglobin levels as a result of bleeding or red cell degeneration, the range will be higher. A high output of red blood cells can indicate anaemia.
  • Test for Bilirubin- Bile contains bilirubin, a yellow pigment that is produced by the liver. The level of bilirubin in the blood can be determined using a blood test. Haemoglobin enters the bloodstream when blood cells decompose. Bilirubin is produced when hemoglobin is broken down. Jaundice is the result of this, and it manifests as yellowing of the skin and eyes. A high blood bilirubin level may indicate anaemia, liver injury, or another illness.
  • Test for Haemoglobin- The liver makes the protein haptoglobin. It links a particular type of blood haemoglobin inside the body. Haptoglobin concentration in the blood reveals the rate of red blood cell oxidation.
  • Test for cold agglutinins- A rare form of AIHA called cold agglutinin disease causes symptoms to worsen when a person is exposed to temperatures between 32 and 50 degrees Fahrenheit. Red blood cells clump together as a result of antibodies called agglutinins. Warm agglutinins are active at body-normal temperatures, while cold agglutinins are active in cold environments.

Sometimes it can be helpful to understand why the disorder is developing to determine whether there are warm or cold agglutinins.

Warm agglutinins may appear in:

  • Specific illnesses, like mycoplasma pneumonia
  • Several pharmaceuticals, such as penicillin

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Treatment of Autoimmune Hemolytic Anemia 

Your doctor will first address the underlying condition that's causing anemia, such as lupus. If a drug is the culprit, you'll probably need to stop taking it. If your AIHA is minor, treatment might not be necessary.

Steroids like hydrocortisone or prednisone are frequently the first medications prescribed by doctors to halt the immune system from attacking your red blood cells. The drug rituximab may enhance the effects of steroids.

You might require surgery to have your spleen removed if things don't get better. The majority of red blood cell oxidation happens there.

To suppress the immune system, one can take medications like azathioprine (Imuran) and cyclophosphamide (Cytoxan).

You could require a blood transfusion.

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