Patient education: Autoimmune hemolytic anemia (The Basics)

What is autoimmune hemolytic anemia? — 

This is a type of hemolytic anemia. Anemia is when you have too few red blood cells or too little hemoglobin. Red blood cells are the cells in your blood that carry oxygen. Hemoglobin is the main protein inside the red blood cells. If you have too few red blood cells or too little hemoglobin, your body might not get all of the oxygen it needs.

"Hemolytic" anemia happens when red blood cells are destroyed. In other types of anemia, the body might not make enough red blood cells.

Autoimmune hemolytic anemia happens because antibodies, which are part of the immune system, destroy red blood cells. The immune system is the body's infection-fighting system. Normally, it makes antibodies against germs like bacteria or viruses. If antibodies attack healthy cells, this is called an "autoimmune" response. If antibodies are made against your red blood cells, you can get autoimmune hemolytic anemia.

What causes autoimmune hemolytic anemia? — 

In many cases, there is no specific cause, and it just happens. But sometimes, it is related to:

●Infections such as pneumonia and mononucleosis (also called "mono")

●Certain types of cancer, including chronic lymphocytic leukemia ("CLL"), multiple myeloma, and lymphoma. Lymphoma is a type of cancer that affects cells of the immune system.

●Autoimmune diseases such as lupus – In people with lupus, the immune system can attack cells and organs all over the body.

●Certain medicines, including some antibiotics

Most of the time, these things do not cause autoimmune hemolytic anemia.

What are the symptoms of autoimmune hemolytic anemia? — 

Symptoms are the same as in other types of anemia. They might include:

●Feeling very tired

●Fast heartbeat

●Trouble breathing

●Headache and muscle pains

Some types of autoimmune hemolytic anemia cause other symptoms, such as reddish or brown urine or sensitivity to cold.

When the doctor does an exam, they might see pale skin or a pale color in the tissue that lines the inside of your eyelids. You can see this tissue (called "conjunctiva") by gently pulling down your lower eyelid. It will look pale instead of its normal, pinkish-red color.

Is there a test for autoimmune hemolytic anemia? — 

Yes. There are blood tests for anemia. Other blood tests are used to check for hemolytic anemia. The most important ones are:

●Reticulocyte count – This can show if your body is trying to make more red blood cells.

●Haptoglobin, bilirubin, and LDH – These can show if red blood cells are being destroyed.

If hemolytic anemia is found, doctors can do more tests to check if it is caused by antibodies or something else. The main test is called the direct antiglobulin test (also called the "DAT" or "Coombs test"). It checks for antibodies against red blood cells. Other tests can help figure out the types of antibodies your body is making.

How is autoimmune hemolytic anemia treated? — 

Treatments can include:

●Medicines that make your body's immune system less active – Doctors usually try a steroid medicine (prednisone or solumedrol) first. Others include cyclophosphamide (brand name: Cytoxan) and rituximab (brand name: Rituxan).

●If the autoimmune hemolytic anemia is due to a condition like CLL or lupus, treating that condition might also treat the anemia.

●If the anemia is very severe, it might be treated with blood transfusions.

●In some cases, your doctor might suggest surgery to remove an organ called the spleen. In some types of autoimmune hemolytic anemia, the spleen is where the red blood cells are destroyed. Surgery to remove the spleen is called "splenectomy." Your doctor can talk to you about the risks and benefits and whether it is right for you.

More on this topic

Patient education: Anemia overview (The Basics)
Patient education: Oral steroid medicines (The Basics)
Patient education: Splenectomy (The Basics)
Patient education: Intravenous immune globulin (IVIG) (The Basics)
Patient education: Coombs test (The Basics)