Quesmed videos (haemolytic anaemia 5) Flashcards
What is warm autoimmune haemolytic anaemia?
The most common form of autoimmune haemolytic anaemia (AIHA).
The “warm” in its name refers to the autoantibodies generated by the body, which are active only at body temperatures
Cold autoimmune haemolytic anaemia is more common than warm autoimmune haemolytic anaemia. True/false?
False
Warm autoimmune haemolytic anaemia is more common than cold.
Accounts for 80-90% of cases.
What is the underlying pathology of warm autoimmune haemolytic anaemia?
In warm autoimmune haemolytic anaemia, the IgG antibodies bind to antigens on the RBC membrane, this triggers the macrophages to antibodies and cause RBC haemolysis.
What blood test features indicate haemolytic anaemia?
Normocytic anaemia
Raised LDH
Raised unconjugated bilirubin
What immunoglobulin mediates warm autoimmune haemolytic anaemia and what type of process is warm autoimmune haemolytic anaemia?
IgG mediated - extravascular splenic phagocytosis
What temperature does warm autoimmune haemolytic anaemia usually occur?
> /=37 degrees celsius which is typical internal body temperature
Causes of warm autoimmune haemolytic anaemia?
Idiopathic
Lymphoproliferative malignancies i.e. CLL, lymphoma
Inflammatory conditions i.e. SLE
Infection i.e. HIV, EBV
Medications: methyldopa, penicillin, cephalosporin.
How is warm autoimmune haemolytic anaemia diagnosed?
Direct coombes test will show a positive result.
Apart from a positive direct Coombes test, what else would be shown for warm autoimmune haemolytic anaemia?
Severe normocytic anaemia
Raised bilirubin
Raised LDH
Raised reticulocytes
What is the treatment for warm autoimmune haemolytic anaemia?
Hb < 70g/l - transfusion
Steroids i.e. prednisolone (first line)
Immunosuppressants i..e monoclonal antibodies, azathioprine
Refractory cases - splenectomy
What type of autoimmune haemolytic anaemia is plasmapheresis typically used for?
Cold autoimmune haemolytic anaemia
What is ferrous fumarate typically used for?
Iron-deficiency anaemia
What is hydroxocobalamin used for?
Anaemia that occurs due to vitamin B12 deficiency.
This would usually show high MCV RBC’s on blood film.
What is first line for warm autoimmune haemolytic anaemia?
Prednisolone
What is the primary cause of both warm and cold autoimmune haemolytic anaemia?
Idiopathic
