Mixed autoimmune hemolytic anemia

Short description: Rare autoimmune disease

Mixed autoimmune hemolytic anemia

Specialty| Hematology

Mixed autoimmune hemolytic anemia (MAIHA) is a type of autoimmune hemolytic anemia which combines the features of cold sensitive antibody-induced diseases and warm autoimmune hemolytic anemia. The work-up for diagnosis is complex and the condition can be over-diagnosed.[1][2][better source needed]

People diagnosed with warm autoimmune hemolytic anemia (WAIHA) caused by immunoglobulin G (IgG)[3] may also have a high number of immunoglobulin M (IgM) antibodies. These antibodies are active at room temperature, but are believed to be harmless since they are not the main antibodies responsible for WAIHA.[citation needed]

However, studies revealed the existence of a few cases of WAIHA that may also carry cold agglutinin antibodies that are active at the environment where the temperatures is generally equal to or warmer than 30 °C (86 °F). Such coexistence suggests a diagnosis of the mixed (warm- and cold-antibody) autoimmune hemolytic anemia abbreviated as MAIHA.[4][better source needed]

Mixed warm and cold AIHA runs a chronic course with severe intermittent exacerbations, such as serious anemia, and is treated by blood transfusion. Successful therapeutic options for the treatment of hemolysis associated with mixed AIHA are limited but increasing.[5][non-primary source needed][6][better source needed]

In the past, there were two obvious sources of error regarding the diagnosis of AIHA. First, patients with w-AIHA can produce low-titer, low-thermal amplitude CA of no clinical significance. Second, up to 20% of patients with CAD have IgG on the RBC surface in addition to C3d.[7][1][6][non-primary source needed]

## See also

* Thermal amplitude (medical)

## References

1. ↑ 1.0 1.1 Mayer, Beate; Yürek, Salih; Kiesewetter, Holger; Salama, Abdulgabar (2008). "Mixed-type autoimmune hemolytic anemia: differential diagnosis and a critical review of reported cases". Transfusion (Wiley) 48 (10): 2229–2234. doi:10.1111/j.1537-2995.2008.01805.x. ISSN 0041-1132. PMID 18564390.
2. ↑ Berentsen, Sigbjørn; Sundic, Tatjana (2015-01-29). "Red Blood Cell Destruction in Autoimmune Hemolytic Anemia: Role of Complement and Potential New Targets for Therapy". BioMed Research International (Hindawi Limited) 2015: 363278. doi:10.1155/2015/363278. ISSN 2314-6133. PMID 25705656.
3. ↑ "Orphanet: Autoimmune hemolytic anemia, warm type". 2019-02-14. https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=EN&Expert=90033.
4. ↑ Das, SudiptaSekhar; Chakrabarty, Ritam; Zaman, RU (2018). "Immunohematological and clinical characterizations of mixed autoimmune hemolytic anemia". Asian Journal of Transfusion Science (Medknow) 12 (2): 99–104. doi:10.4103/ajts.ajts_105_17. ISSN 0973-6247. PMID 30692792.
5. ↑ Gupta, Shilpi; Szerszen, Anita; Nakhl, Fadi; Varma, Seema; Gottesman, Aaron; Forte, Frank; Dhar, Meekoo (2011-04-19). "Severe refractory autoimmune hemolytic anemia with both warm and cold autoantibodies that responded completely to a single cycle of rituximab: a case report". Journal of Medical Case Reports (Springer Nature) 5 (1): 156. doi:10.1186/1752-1947-5-156. ISSN 1752-1947. PMID 21504611.
6. ↑ 6.0 6.1 Berentsen, Sigbjørn; Sundic, Tatjana (2015-01-29). "Red Blood Cell Destruction in Autoimmune Hemolytic Anemia: Role of Complement and Potential New Targets for Therapy". BioMed Research International (Hindawi Limited) 2015: 363278-1–363278-11. doi:10.1155/2015/363278. ISSN 2314-6133. PMID 25705656.
7. ↑ Berentsen, S; Ulvestad, E; Langholm, R; Beiske, K; Hjorth-Hansen, H; Ghanima, W; Sørbø, JH; Tjønnfjord, GE (2006). "Primary chronic cold agglutinin disease: a population based clinical study of 86 patients.". Haematologica 91 (4): 460–6. ISSN 0390-6078. PMID 16585012.

* v
* t
* e

Diseases of red blood cells

| Polycythemia|

* Polycythemia vera

|

| Anemia|

| Nutritional|

* Micro-: Iron-deficiency anemia
* Plummer–Vinson syndrome

* Macro-: Megaloblastic anemia
* Pernicious anemia

|

Hemolytic
(mostly normo-)|

| Hereditary|

* enzymopathy: Glucose-6-phosphate dehydrogenase deficiency
* glycolysis
* pyruvate kinase deficiency
* triosephosphate isomerase deficiency
* hexokinase deficiency

* [[Biology:Hemoglobinopathemoglobinopathy]]: Thalassemia
* alpha
* beta
* delta
* Sickle cell disease/trait
* Hereditary persistence of fetal hemoglobin

* membrane: Hereditary spherocytosis
* Minkowski–Chauffard syndrome
* Hereditary elliptocytosis
* Southeast Asian ovalocytosis
* Hereditary stomatocytosis

|

Acquired|

| AIHA|

* Warm antibody autoimmune hemolytic anemia
* Cold agglutinin disease
* Donath–Landsteiner hemolytic anemia
* Paroxysmal cold hemoglobinuria
* Mixed autoimmune hemolytic anemia

|

* membrane
* paroxysmal nocturnal hemoglobinuria

* Microangiopathic hemolytic anemia
* Thrombotic microangiopathy
* Hemolytic–uremic syndrome

* Drug-induced autoimmune
* Drug-induced nonautoimmune

* Hemolytic disease of the newborn

Aplastic
(mostly normo-)|

* Hereditary: Fanconi anemia
* Diamond–Blackfan anemia

* Acquired: Pure red cell aplasia
* Sideroblastic anemia
* Myelophthisic

Blood tests|

* Mean corpuscular volume
* normocytic
* microcytic
* macrocytic
* Mean corpuscular hemoglobin concentration
* normochromic
* hypochromic

Other|

* Methemoglobinemia
* Sulfhemoglobinemia
* Reticulocytopenia

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