Mixed‐type autoimmune hemolytic anemia: differential diagnosis and a critical review of reported cases

Abstract

There is evidence that the presence of CAs with high thermal amplitude and WABs may lead to confusion and misdiagnosis in some patients with AIHA. This study demonstrates that Mx AIHA is less common than previously reported.

Autoimmune Hemolytic Anemia: Mixed Type—A Case Report

“…Occurrence of mixed type of AIHA is rare with \5% of all cases of AIHA reported and in children they are extremely rare [4,5].We report one such rare case of mixed warm and cold type of AIHA in a 12 year old girl with review of literature.…”

Look No Further: An Exercise in Clinical Reasoning

“…1 It is most commonly associated HIV infection, although less common causes include non- Hodgkin's lymphoma, systemic lupus erythematosus (SLE), and Evans syndrome. 1,2 Lymphoma is unlikely given the result of the excisional biopsy, and the pre-test probabilities of both SLE and Evans syndrome are low given the negative ANA and the lack of thrombocytopenia, respectively. In light of the known association between mixed AIHA and HIV, as well as the diffuse lymphadenopathy, an HIV test should be obtained.…”

Autoimmune hemolytic anemia: transfusion challenges and solutions

“…DAT shows positive reaction with anti-IgG and anti-C3d reagents, and the eluate contains the IgG autoantibody. 9,13,14 MAIHA patients may also present clinically significant alloantibodies that are reactive at 37°C, therefore the application of additional technical procedures may be necessary.…”

“…13 In a study including a larger sample of patients, Mayer et al established diagnosis of MAIHA in only two (<0.1%) out of 2,194 patients with warm autoantibody and concluded that the presence of cold antibodies with high thermal amplitude associated with warm antibodies may lead to confusion and misdiagnosis in some patients with AIHA. 14 The serological findings in patients with MAIHA are the presence of cold autoantibodies with a high thermal amplitude (>30°C) in association with warm autoantibodies. In contrast to the typical CAS, the IgM autoantibodies seen in MAIHA usually present low titles (1:64) at 4°C or less, but have great thermal amplitude, with reactivity to 37°C.…”

“…RBC transfusion may be necessary particularly for the symptomatic elderly, for patients with coronary artery disease with increased risk of cardiac or cerebral events, and life-threatening situations related to the anemia. 13,14,[17][18][19][20] First-line treatment of individuals with AIHA consists of glucocorticoids that often results in early improvement of the hemolytic state interrupting the hemoglobin level decrease usually 24-72 hours after therapy has been started. Another possible initial treatment for severe or refractory patients is the use of anti-CD20 monoclonal antibody (rituximab) that may rapidly reduce the hemolysis making RBC transfusion unnecessary.…”