Autoimmune hemolytic anemia - Revision history

ClaireLewis: /* Clinical Features */

2019-09-30T23:57:28Z

Clinical Features

← Revisión anterior		Revisión del 23:57 30 sep 2019
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	*Signs/symptoms of underlying disease process		*Signs/symptoms of underlying disease process
	*Cold-type:		*Cold-type:
	**Acrocyanosis, [[~~raynaud's~~ disease\|Raynaud's]], vascular occlusion with ~~peripehral~~ tissue ischemia		**Acrocyanosis, [[Raynaud’s disease\|Raynaud's]], vascular occlusion with peripheral tissue ischemia

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 23:56, 30 September 2019

2019-09-30T23:56:46Z

← Revisión anterior		Revisión del 23:56 30 sep 2019
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	==Background==		==Background==
	*Autoimmune hemolytic anemia (AIHA) = generation of auto-antibodies towards red blood cell membrane antigens, leady to hemolysis.		*Autoimmune [[hemolytic anemia]] (AIHA) = generation of auto-antibodies towards red blood cell membrane antigens, leady to hemolysis.
	*Can be primary (~~idopathic~~) or due to another disease process (e.g. malignancy, autoimmune disease, infection)		*Can be primary (idiopathic) or due to another disease process (e.g. malignancy, autoimmune disease, infection)

	==="Warm" Autoimmune Hemolytic Anemia===		==="Warm" Autoimmune Hemolytic Anemia===
	''Autoantibodies agglutinate to RBCs at higher temperatures''		''Autoantibodies agglutinate to RBCs at higher temperatures''
	*IgG mediated, usually pan-reactive to patient's and transfused RBCs		*IgG mediated, usually pan-reactive to patient's and transfused RBCs
	*Extravascular (i.e. in spleen) hemolysis→ unconjugated > conjugated hyperbilirubinemia		*Extravascular (i.e. in spleen) hemolysis→ unconjugated > conjugated [[hyperbilirubinemia]]
	*Haptoglobin low, LDH may be normal		*Haptoglobin low, LDH may be normal
	*Causes:		*Causes:
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	**Collagen vascular diseases (E.g. [[Systemic Lupus Erythematosus]], [[Rheumatoid arthritis]], [[Giant cell arteritis]]		**Collagen vascular diseases (E.g. [[Systemic Lupus Erythematosus]], [[Rheumatoid arthritis]], [[Giant cell arteritis]]
	**Viral-induced or [[HIV]]-associated		**Viral-induced or [[HIV]]-associated
	**Medications: methyldopa, quinidine, [[penicillin]]		**Medications: methyldopa, [[quinidine]], [[penicillin]]

	==="Cold" Autoimmune Hemolytic Anemia===		==="Cold" Autoimmune Hemolytic Anemia===
Línea 29:		Línea 29:
	*Signs/symptoms of underlying disease process		*Signs/symptoms of underlying disease process
	*Cold-type:		*Cold-type:
	**Acrocyanosis, Raynaud's, vascular occlusion with peripehral tissue ischemia		**Acrocyanosis, [[raynaud's disease\|Raynaud's]], vascular occlusion with peripehral tissue ischemia

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis: /* Management */

2019-09-01T15:00:13Z

Management

← Revisión anterior		Revisión del 15:00 1 sep 2019
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	*Oral [[prednisone]] 1-1.5mg/kg/day for 1-3 weeks with taper after hemoglobin stable		*Oral [[prednisone]] 1-1.5mg/kg/day for 1-3 weeks with taper after hemoglobin stable
	**may need several months of low dose [[prednisone]] to remain in remission		**may need several months of low dose [[prednisone]] to remain in remission
	*Splenectomy and/or cytotoxic drugs for for steroid-refractory disease		*[[Splenectomy]] and/or cytotoxic drugs for for steroid-refractory disease
	*~~Plasmapharesis~~ as temporizing measure for severe disease		*[[Plasmapheresis]] as temporizing measure for severe disease
	*Transfuse only if truly life-threatening anemia, least incompatible units possible		*Transfuse [[pRBCs]] only if truly life-threatening anemia, least incompatible units possible

	===Cold AIHA===		===Cold AIHA===
	*No treatment for mild disease		*No treatment for mild disease
	*Immunosuppressive or cytotoxic medications can be considered		*Immunosuppressive or cytotoxic medications can be considered
	*~~Plasmapharesis~~ for severe disease		*[[Plasmapheresis]] for severe disease

	==Disposition==		==Disposition==

Mholtz: Text replacement - "==Treatment==" to "==Management=="

2017-12-10T23:34:40Z

Text replacement - "==Treatment==" to "==Management=="

← Revisión anterior		Revisión del 23:34 10 dic 2017
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	*Direct Coombs test - blood sample is removed of plasma and incubated with anti-human immunoglobulin (aka "Coombs reagent"). This detects if autoantibodies are attached to RBCs or compliment. If the RBCs are coated with IgG (positive direct Coombs test), this suggests the diagnosis of "warm AIHA. If the RBCs are coated with only compliment, this suggests the diagnosis of "cold" AIHA		*Direct Coombs test - blood sample is removed of plasma and incubated with anti-human immunoglobulin (aka "Coombs reagent"). This detects if autoantibodies are attached to RBCs or compliment. If the RBCs are coated with IgG (positive direct Coombs test), this suggests the diagnosis of "warm AIHA. If the RBCs are coated with only compliment, this suggests the diagnosis of "cold" AIHA

	==~~Treatment~~==		==Management==
	===Warm AIHA===		===Warm AIHA===
	*Oral [[prednisone]] 1-1.5mg/kg/day for 1-3 weeks with taper after hemoglobin stable		*Oral [[prednisone]] 1-1.5mg/kg/day for 1-3 weeks with taper after hemoglobin stable

Mholtz: Text replacement - "==References== " to "==References== "

2017-07-24T01:12:36Z

Text replacement - "==References== " to "==References== <references/> "

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	==References==		==References==
			<references/>
	[[Category:Heme/Onc]]		[[Category:Heme/Onc]]

Mholtz: Text replacement - "-->" to "→"

2017-02-08T22:51:53Z

Text replacement - "-->" to "→"

← Revisión anterior		Revisión del 22:51 8 feb 2017
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	''Autoantibodies agglutinate to RBCs at higher temperatures''		''Autoantibodies agglutinate to RBCs at higher temperatures''
	*IgG mediated, usually pan-reactive to patient's and transfused RBCs		*IgG mediated, usually pan-reactive to patient's and transfused RBCs
	*Extravascular (i.e. in spleen) ~~hemolysis-->~~ unconjugated > conjugated hyperbilirubinemia		*Extravascular (i.e. in spleen) hemolysis→ unconjugated > conjugated hyperbilirubinemia
	*Haptoglobin low, LDH may be normal		*Haptoglobin low, LDH may be normal
	*Causes:		*Causes:
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	''Autoantibodies agglutinate at lower temperatures''		''Autoantibodies agglutinate at lower temperatures''
	*IgM mediated		*IgM mediated
	*Intravascular ~~hemolysis-->~~ high LDH, low haptoglobin, hemoglobinuria		*Intravascular hemolysis→ high LDH, low haptoglobin, hemoglobinuria
	*Causes:		*Causes:
	**Infection, most commonly [[Mycoplasma pneumoniae]] and [[mononucleosis]], also [[varicella]], [[listeria]], [[influenza]]		**Infection, most commonly [[Mycoplasma pneumoniae]] and [[mononucleosis]], also [[varicella]], [[listeria]], [[influenza]]

ClaireLewis: /* "Warm" Autoimmune Hemolytic Anemia */

2016-12-22T21:50:01Z

"Warm" Autoimmune Hemolytic Anemia

← Revisión anterior		Revisión del 21:50 22 dic 2016
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	*Causes:		*Causes:
	**[[Lymphoma]], especially Non-Hodgkin's lymphoma		**[[Lymphoma]], especially Non-Hodgkin's lymphoma
	**[[Leukemia]], particularly chronic lymphocytic leukemia		**[[Leukemia]], particularly [[chronic lymphocytic leukemia]]
	**Collagen vascular diseases (E.g. [[Systemic Lupus Erythematosus]], [[Rheumatoid arthritis]], [[Giant cell arteritis]]		**Collagen vascular diseases (E.g. [[Systemic Lupus Erythematosus]], [[Rheumatoid arthritis]], [[Giant cell arteritis]]
	**Viral-induced or [[HIV]]-associated		**Viral-induced or [[HIV]]-associated

Neil.m.young: Text replacement - "* " to "*"

2016-10-27T17:55:16Z

Text replacement - "* " to "*"

← Revisión anterior		Revisión del 17:55 27 oct 2016
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	**[[Lymphoma]], especially Non-Hodgkin's lymphoma		**[[Lymphoma]], especially Non-Hodgkin's lymphoma
	**[[Leukemia]], particularly chronic lymphocytic leukemia		**[[Leukemia]], particularly chronic lymphocytic leukemia
	** Collagen vascular diseases (E.g. [[Systemic Lupus Erythematosus]], [[Rheumatoid arthritis]], [[Giant cell arteritis]]		**Collagen vascular diseases (E.g. [[Systemic Lupus Erythematosus]], [[Rheumatoid arthritis]], [[Giant cell arteritis]]
	**Viral-induced or [[HIV]]-associated		**Viral-induced or [[HIV]]-associated
	**Medications: methyldopa, quinidine, [[penicillin]]		**Medications: methyldopa, quinidine, [[penicillin]]

Rossdonaldson1: Text replacement - "prednisone " to "prednisone "

2016-09-20T22:49:35Z

Text replacement - "prednisone " to "prednisone "

← Revisión anterior		Revisión del 22:49 20 sep 2016
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	===Warm AIHA===		===Warm AIHA===
	*Oral [[prednisone]] 1-1.5mg/kg/day for 1-3 weeks with taper after hemoglobin stable		*Oral [[prednisone]] 1-1.5mg/kg/day for 1-3 weeks with taper after hemoglobin stable
	**may need several months of low dose prednisone to remain in remission		**may need several months of low dose [[prednisone]] to remain in remission
	*Splenectomy and/or cytotoxic drugs for for steroid-refractory disease		*Splenectomy and/or cytotoxic drugs for for steroid-refractory disease
	*Plasmapharesis as temporizing measure for severe disease		*Plasmapharesis as temporizing measure for severe disease

ClaireLewis at 23:06, 10 September 2016

2016-09-10T23:06:35Z

← Revisión anterior		Revisión del 23:06 10 sep 2016
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	==References==		==References==

			[[Category:Heme/Onc]]