Bay Biosciences provides high quality, clinical grade bio-specimens, cryogenically preserved K2EDTA plasma and peripheral blood mononuclear cells (PBMC) biofluid samples from patients diagnosed with autoimmune hemolytic anemia.
The K2EDTA plasma and PBMC biofluid specimens are processed from patient’s peripheral whole-blood using customized collection and processing protocols.
The autoimmune hemolytic anemia bio-specimens are collected from unique patients diagnosed with cold autoimmune hemolytic anemia and are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Autoimmune Hemolytic Anemia Overview
Autoimmune hemolytic anemia is a rare red blood cell disorder and an immune disorder. It happens when the body produces antibodies that destroy the red blood cells.
Hemolytic anemia develops when there are not enough red blood cells because the body destroys them sooner than it should. Red blood cells carry oxygen around the body.
Autoimmune hemolytic anemia (AIHA), or immune hemolytic anemia, happens when the immune system does not work properly. It mistakes red blood cells for unwanted substances and attacks them, causing them to die early. This leaves a person without enough red blood cells.
Normally, red blood cells live in the body for 100 to 120 days. However, in severe cases of AIHA, the cells may remain only for a few days.
In children, it is a rare condition that is usually temporary. In some adults, however, AIHA can be a long-term condition that returns frequently. AIHA can develop rapidly or over time.
Causes of Autoimmune Hemolytic Anemia
Blood cells are made in the bone marrow bone marrow.
There are three basic types:
- Platelets help blood to clot and prevent bleeding.
- Red blood cells transport oxygen throughout the body in the form of hemoglobin.
- White blood cells help the body to fight off fight infections.
White blood cells produce antibodies. Antibodies attach to red blood cells and travel throughout the body, fighting germs and other foreign substances that should not be there.
In autoimmune hemolytic anemia (AIHA), the body makes antibodies that attack the red blood cells because they think they are foreign or unwanted substances. They destroy the red blood cells, and this results in anemia.
This may happen because of:
- A complication of an infection
- Exposure to certain toxins or chemicals, for example in medications
- An unborn baby’s blood type being different from that of their mother
- Receiving a blood transfusion when the blood does not match the individual’s blood type
- Some types of cancer
Types and Risk Factors of Autoimmune Hemolytic Anemia
There are two classifications for AIHA: warm versus cold and primary versus secondary.
The warm or cold classification depends on the type of antibodies involved.
Warm AIHA
Also called warm hemolysis, this involves IgG antibodies. These bind red blood cells at 98.6°F (37°C), or normal body temperature. This accounts for 80–90 percent of cases.
Symptoms usually appear gradually, over a period of several weeks to months. Sometimes, however, they can emerge suddenly, within a few days.
They include the following:
- Dizziness
- Heart palpitations
- Pale or yellowing of skin
- Tiredness
Cold AIHA
This is also called cold hemolysis. In this type, IgM autoantibodies, or cold agglutinins, bind red blood cells when the blood is exposed to cold temperatures, specifically 32° to 39.2°F (0° to 4°C). This accounts for 10–20 percent of cases.
Cold temperatures or a viral infection can trigger symptoms, which include:
- Blue coloring and pain in the hands and feet
- Cold anb hand feet
- Diarrhea
- Heart problems, such as arrhythmia, a heart murmur, an enlarged or heart failure
- Pale or yellowing of skin
- Tiredness and dizziness
- Pain in the chest and the backs of the legs
- Raynaud’s disease
- Vomiting
Some common viruses may trigger AIHA. Often, the antibodies and anemia go away once the infection has gone.
Viruses that appear to have a link with AIHA include the following:
- Cytomegalovirus
- Epstein-Barr virus (EBV)
- Hepatitis
- HIV
- Mycoplasma pneumonia
- Measles
- Mumps
- Rubella
- rubella
- Varicella, which causes chickenpox
These viruses can trigger changes to antibodies that can lead to AIHA.
Types of drugs that, in rare cases, may trigger changes that lead to AIHA include:
- Acetaminophen
- Cephalosporins
- Ibuprofen
- Erythromycin
- Penicillins
- Tetracycline
A person can also inherit antibodies from their mother at birth, but this is rare.
Autoimmune Hemolytic Anemia in Children
AIHA can occur in children. However, according to the University of Chicago, fewer than 0.2 people in every 100,000 have AIHA before the age of 20 years. The highest rates are in pre-school age children.
When AIHA occurs in children, it is usually the result of a virus or infection.
Often no treatment is necessary, and symptoms will pass without intervention. Children who need treatment will have the same treatment options as adults.
AIHA can disrupt a child’s everyday routine due to tiredness and the need for ongoing medical support, including tests.
Parents and caretakers should ensure that the child:
- Follows a well-balanced diet
- Gets plenty of rest and fluids
- Plans activities in a way that will enable the child to manage their condition
A doctor will discuss a specific treatment plan.
Signs and Symptoms of Autoimmune Hemolytic Anemia
Following are the common signs and symptoms of AIHA:
- A low-grade fever
- Difficulty thinking and concentrating
- Diarrhea
- Difficulty breathing
- A sore tongue
- Dark urine
- Headaches
- Heart palpitations or a rapid heartbeat
- Lightheadedness when standing up
- Paleness
- Rapid heartbeat
- Muscle pains
- Shortness of breath
- Yellowing skin, or jaundice
- Nausea and vomiting
- Weakness and tiredness
Diagnosis of Autoimmune Hemolytic Anemia
A doctor will ask about symptoms and carry out a physical examination. They may then order some blood and urine tests to help with the diagnosis.
Complete Blood Count
The complete blood count (CBC) measures the different parts that make up the blood.
It includes measuring the hemoglobin and hematocrit levels.
- Hemoglobin is a protein that carries oxygen throughout the body.
- Hematocrit shows how much space red blood cells take up.
Low levels of both can be a sign of anemia.
Coombs Tests
These blood tests look for antibodies that may affect the red blood cells.
Reticulocyte Test
This blood test measures the levels of reticulocytes, which are slightly immature red blood cells. It can determine whether the bone marrow is creating red blood cells at a suitable rate.
The range will be higher if the body has low hemoglobin levels due to bleeding or red cell destruction. High red blood cells production can be a sign of anemia.
Bilirubin Test
The liver produces bilirubin, a yellow-colored substance that is present in bile. A blood test can measure the amount of bilirubin in the blood.
When blood cells die, hemoglobin enters the bloodstream. Hemoglobin, in turn, breaks down into bilirubin. This leads to jaundice, when the eyes and skin take on a yellowish color.
High bilirubin levels in the blood can be a sign of anemia, liver damage, or another disease.
Haptoglobin Test
Haptoglobin is a protein that the liver produces. Within the body, it connects a specific type of hemoglobin within the blood.
The amount of haptoglobin in the blood shows how fast red blood cells are being destroyed.
Cold Agglutinins Test
Cold agglutinin disease is a rare type of AIHA in which symptoms become worse when a person is in temperatures between 32º and 50º Fahrenheit.
Agglutinins are antibodies that cause red blood cells to clump together. Cold agglutinins are active at cold temperatures, and warm agglutinins are active at normal body temperatures.
Determining whether there are warm or cold agglutinins can sometimes help explain why the disorder is occurring.
Warm agglutinins can occur with:
- Certain infections, such as mycoplasma pneumonia
- Some medications, including penicillin
Treatment of Autoimmune Hemolytic Anemia
Treatment options for AIHA depend on a number of factors. If the anemia is mild, it often passes without treatment. Between 70 and 80 percent of people need no treatment or minimal intervention.
However, some people will need medication, surgery, or a blood transfusion.
Factors affecting the need for treatment include:
- Cause of the condition
- Patients age, overall health, and medical history
- How severe the anemia is
- Individual’s tolerance for specific treatments
- How health providers expect the symptoms to progress
If there is an underlying cause, such as cancer, an infection, or the use of some medications, treating the condition or changing the medication may reduce the symptoms of AIHA.
Medication
A doctor may prescribe corticosteroids or cortisone-like drugs to weaken the immune response.
This is generally the first type of treatment for people with primary AIHA, and it can help to improve symptoms in many common types of AIHA.
In severe cases, and if these drugs do not work, a doctor may prescribe other drugs that suppress the immune response, known as immunosuppressive therapy.
This drug treatment helps to lower the body’s immune response. The drugs help to prevent the immune system from attacking its own bone marrow. Doing so allows the marrow stem cells to grow, and this can increase red blood counts.
However, both cortisone and immunosuppressant drugs can have adverse effects.
Surgery
If drug treatment is not effective, a doctor may recommend surgery.
The spleen is responsible for removing abnormal red blood cells from the bloodstream, including those with antibodies attached. Removing the spleen can enable the body to preserve those red blood cells. This can help to prevent anemia.
Blood Transfusion
If symptoms are severe and other options are not effective, the person may need a blood transfusion.
Prevention of Autoimmune Hemolytic Anemia
It is not possible to prevent some types of AIHA, but doctors can monitor people who have a viral infection or who use certain medications, to ensure that AIHA does not develop.
Severe anemia can worsen many problems, such as heart and lung disease. People should contact a doctor if they experience any symptoms that may indicate AIHA.
Lifestyle and Management of Autoimmune Hemolytic Anemia
If someone has AIHA, their doctor will work with them to help reduce symptoms and the chance of complications.
Tips to reduce the risk of worsening symptoms or complications include:
- Avoiding people with infections or who are sick
- Having an annual flu shot
- Washing hands and brushing teeth regularly to reduce the risk of oral and other infections
Outlook
The outlook for AIHA is usually good. The condition usually lasts for a limited time.
If it occurs during the teenage years, it can become a long-term condition. However, medical treatment can help reduce the impact.
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