Autoimmune Hemolytic Anemia

Autoimmune hemolytic anemia (AIHA) is a rare form of anemia (low levels of red blood cells). It happens when your immune system accidentally destroys your red blood cells. The condition causes symptoms like fatigue, feeling short of breath or having a rapid heartbeat.

Healthcare providers classify AIHA as being primary or secondary. Primary AIHA is when you have the condition but don’t have one of the issues that can cause AIHA. Secondary AIHA is when another issue, like a virus or blood cancer, leads to autoimmune hemolytic anemia.

Types of autoimmune hemolytic anemia

There are two types: warm AIHA and cold AIHA. The difference is the type of antibodies that your immune system makes to attack red blood cells. Antibodies are proteins that fight intruders like viruses and cancer. In AIHA, specific antibodies target red blood cells at different body temperatures:

• Warm AIHA: This type involves immunoglobulin G (IgG) antibodies. It’s called warm AIHA because the antibodies target red blood cells when your body temperature is at or above 98.6 degrees Fahrenheit (37 degrees Celsius).
• Cold AIHA: This type involves immunoglobulin M (IgM) antibodies. They attack red blood cells when the cells’ temperature is cooler than your body’s core temperature. Healthcare providers may call this cold agglutin disease (CAD).

Symptoms of autoimmune hemolytic anemia

AIHA symptoms may vary depending on AIHA type, but both types have symptoms in common, including:

• Chills and fever
• Dizziness
• Fatigue and weakness
• Fast heart rate
• Shortness of breath
• Skin color that is more pale than usual or has a yellowish tint
• Dark pee

Cold AIHA may cause more symptoms, including:

• Chest pain
• Cold hands and feet
• Pain in the back of your legs

Autoimmune hemolytic anemia causes

In autoimmune hemolytic anemia, your immune system kills red blood cells faster than your body can replace them. This can happen for no reason (primary AIHA). But certain conditions and medications may cause it (secondary AIHA). Those include:

• Autoimmune diseases: Lupus, Hashimoto’s disease and rheumatoid arthritis are some of the autoimmune diseases linked to AHIA.
• Cancer: Chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma are examples of cancer linked to this condition.
• Medications: Antibiotics, anticancer drugs and nonsteroidal anti-inflammatory drugs may cause autoimmune hemolytic anemia.
• Viruses: Examples are cytomegalovirus, Epstein-Barr virus, hepatitis and HIV.

Complications

Autoimmune hemolytic anemia may have complications. These include serious infections, like pneumonia, and heart disease.

How doctors diagnose autoimmune hemolytic anemia

A healthcare provider will ask about your symptoms. They’ll do a physical exam. They may do several blood tests, including:

• Bilirubin test
• CBC
• Coombs test
• LDH
• Peripheral blood smear
• Reticulocyte count
• Serological test

How is AIHA treated?

Your treatment depends on the condition type — cold or warm — and if an underlying issue is responsible. Treatments may include:

• Warm AHIA: Your healthcare provider treats this type with immunosuppressants and corticosteroids. You may have blood transfusions if you have severe anemia.
• Cold AHIA: Rituximab and immunosuppressants are common treatments. Your provider may recommend you take steps to stay warm in cold weather or chilly places.

You may need surgery to remove your spleen if the medications aren’t effective. Your spleen filters and stores blood. In AIHA, your spleen is often where antibodies destroy red blood cells. Removing it may help protect red blood cells before antibodies can harm them.

When should I seek care?

Contact a healthcare provider if you have shortness of breath, fatigue, weakness or other anemia symptoms. There are several different types of anemia. Your provider will do tests to see if AIHA is causing your symptoms.

What can I expect if I have AIHA?

There’s no cure for this condition. Your situation depends on your AIHA type and whether you have a severe form of the condition. If you have this condition, ask your healthcare provider to explain your situation, how treatment will manage your symptoms and what you can expect.