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The most common antibody isotype involved in warm antibody AIHA is IgG, though sometimes IgA is found. The IgG antibodies attach to a red blood cell, leaving their F C portion exposed with maximal reactivity at 37 °C (versus cold antibody induced hemolytic anemia whose antibodies only bind red blood cells at low body temperatures, typically 28–31 °C).
AIHA can be classified as warm autoimmune hemolytic anemia or cold autoimmune hemolytic anemia, which includes cold agglutinin disease and paroxysmal cold hemoglobinuria. These classifications are based on the characteristics of the autoantibodies involved in the pathogenesis of the disease.
Autoimmune hemolytic anemia (AIHA) is an autoimmune disorder which occurs when antibodies directed against the person's own red blood cells (RBCs) cause them to burst , leading to an insufficient number of oxygen-carrying red blood cells in circulation . The lifetime of the RBCs is reduced from the normal 100–120 days to just a few days in ...
[4] [1] Cold agglutinin disease represents an estimated 16–32% of autoimmune hemolytic anemia, whose annual incidence is estimated to be between 1/35,000-1/80,000 in North America and Western Europe. [1] In patients with infectious mononucleosis, more than 60% of whom develop cold agglutinins disease. [25]
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]
In cold hemolytic anemia there is advantage in transfusing warmed blood. In severe immune-related hemolytic anemia, steroid therapy is sometimes necessary. In steroid resistant cases, consideration can be given to rituximab or addition of an immunosuppressant (azathioprine, cyclophosphamide).