Hemolytic anemia: what it is, main symptoms and treatment

Autoimmune hemolytic anemia, also known by the acronym AHAI, is a disease characterized by the production of antibodies that react against red blood cells, destroying them and producing anemia, with symptoms such as tiredness, pallor, dizziness, yellow and bad skin and eyes be

This type of anemia can affect anyone, but it is more common in young adults. Although its cause is not always clarified, it can arise from dysregulation of the immune system after an infection, the presence of another autoimmune disease, the use of certain medications or even cancer.

Autoimmune hemolytic anemia is not always curable, however, it has a treatment that is done mainly with the use of medications to regulate the immune system, such as corticosteroids and immunosuppressants. In some cases, removal of the spleen, called a splenectomy, may be indicated, as this is the place where part of the red blood cells is destroyed. 

Table of Contents

Main symptoms

Symptoms of autoimmune hemolytic anemia include:

  • Weakness;
  • Feeling faint;
  • Pallor;
  • Lack of appetite;
  • Dizziness;
  • Tiredness;
  • I’m;
  • Indisposition;
  • Headache;
  • Weak nails;
  • Dry skin;
  • Loss of hair;
  • Lack of air;
  • Paleness in the mucous membranes of the eyes and mouth;
  • Jaundice.

These symptoms are very similar to those caused by other types of anemia, so it is necessary for the doctor to order tests that can help identify the exact cause, such as the reduced dosage of red blood cells, the high reticulocyte count, which are immature red blood cells, in addition to immunological tests.  

Check out how to differentiate between the causes of anemia .

What are the causes

The cause of autoimmune hemolytic anemia is not always identified, however, in many cases it can be secondary to the presence of other autoimmune diseases, such as lupus and rheumatoid arthritis, cancer, such as lymphomas or leukemias or due to the reaction to medications, such as Levodopa, Methyldopa, anti-inflammatories and certain antibiotics.

It can also arise after infections, such as those caused by viruses such as  Epstein-Barr or Parvovirus B19, or by bacteria such as  Mycobacterium pneumoniae or Treponema pallidum when it causes tertiary syphilis, for example. 

In about 20% of cases, autoimmune hemolytic anemia is worsened by the cold, because in these cases, the antibodies are activated by low temperatures, being called AHAI by cold antibodies. The remaining cases are called AHAI for hot antibodies, and they are the majority.

How to confirm the diagnosis

For the diagnosis of autoimmune hemolytic anemia, the tests the doctor will order include:

  • CBC , to identify anemia and observe its severity;
  • Immunological tests , such as the direct Coombs test, which shows the presence of antibodies attached to the surface of red blood cells. Understand  what the Coombs test means ;
  • Tests that prove hemolysis , such as an increase in reticulocytes in the blood, which are immature red blood cells that appear in the bloodstream in excess in case of hemolysis;
  • Dosage of indirect bilirubin , which increases in cases of severe hemolysis. Know what it is for and when the bilirubin test is indicated .

As several anemias can have similar symptoms and tests, it is very important that the doctor is able to differentiate between the different causes of anemia. Find out more about the tests at: Tests that confirm anemia .

How the treatment is done

It cannot be said that there is a cure for autoimmune hemolytic anemia, as it is common for patients with this disease to experience periods of outbreaks and to improve their condition. 

To live as long as possible in remission period, it is necessary to carry out the treatment that is indicated by the hematologist, made with drugs that regulate the immune system, which include corticosteroids, such as Prednisone, immunosuppressants, such as Cyclophosphamide or Cyclosporine, immunomodulators, such as human immunoglobulin or plasmapheresis, which helps to remove excess antibodies from the bloodstream, in severe cases.

Surgical removal of the spleen, called a splenectomy, is an option in some cases, especially for patients who do not respond well to treatment. As the risk of infection can increase people who remove this organ, vaccines such as pneumococcal and antimeningococcal are recommended. Check out more about care and recovery after spleen removal . 

In addition, the choice of treatment depends on the type of autoimmune hemolytic anemia, the symptoms presented and the severity of each person’s illness. The duration of treatment is variable, and in some cases you can try to start taking the medication after about 6 months to assess the response, depending on the guidance of the hematologist. 

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