Clinically and/or Serologically Misleading Findings Surrounding Immune Haemolytic Anaemias

Abstract

Autoimmune haemolytic anaemias (AIHAs) are well-characterized disorders. They can be differentiated from one another and from other non-immune haemolytic anaemias by clinical, laboratory and serological testing. However, several misleading clinical presentations and/or serological findings may result in misinterpretation, delay and/or misdiagnosis. Such failures are avoidable by adequate clinical and serological experience of the responsible physicians and serologists or, at least, by an optimised bidirectional communication. As long as this has not been achieved, unpleasant failures are to be expected. A true diagnosis of AIHA can neither be verified by clinical nor serological findings alone. Thus, a collective clinical and serological picture remains obligatory for fulfilling the criteria of optimal diagnosis and therapy. Ultimately, the majority of pioneer scientific and practical work in this field stems from scientists who were simultaneously involved in both the clinic and serology.

Treatment Options for Primary Autoimmune Hemolytic Anemia: A Short Comprehensive Review

“…Although hemolysis was initially quite difficult to control in several patients, the vast majority, if not all, survived or had the opportunity to survive hemolysis per se. If the patient deceased, the reason was found to be related to failures in patient management rather than to uncontrolled hemolysis, misdiagnosis [ 86 ], inadequate treatment, treatment complications, or refusal of blood transfusion due to in vitro serological incompatibilities [ 18 ]. Replacement of the aforementioned standard therapy by rituximab, in my opinion, is currently unlikely.…”

Variability of Findings in Drug-Induced Immune Haemolytic Anaemia: Experience over 20 Years in a Single Centre

“…Three of the ddab presented in this article demonstrated such a serological picture. Altogether, there are various pitfalls in the diagnosis and differential diagnosis of DIHA and AIHA, which have also been addressed in another article in this issue [ 53 ].…”

Autoimmunhämolytische Anämien: Diagnose und Therapie

“…Bei der paroxysmalen Kältehämoglobinurie und bei der Autoimmunhämolyse vom Kältetyp sind die Antikörper nicht reaktiv bei Temperaturen ≥ 37°C. Stark agglutinierende IgA-und IgM-Wärme-AAK werden häufig als Kälte-AAK angesehen [11].…”

“…Differenzialdiagnostisch kommen grunderkrankungsassoziierte Anämie, aplastische Anämie, hämolytische Transfusionsreaktionen, nicht immunologisch bedingte Hämolyse, medikamentös induzierte Hämolyse und nicht transplantationsinduzierte AIHA vom Wärmetyp infrage [11]. Das Fehlen des letzteren Proteins ist die Hauptursache für eine gesteigerte Empfindlichkeit von PNH-Erythrozyten gegenüber Komplement.…”