AIHA Still Requires Much Research to Validate Treatments

[Guest guest]

Presse Med. 2007 May 2; [Epub ahead of print] [Autoimmune

hemolytic anemia: diagnosis and management.][Article in French]

Philippe P.

Service de medecine interne, Hotel-Dieu, CHU de Clermont-Ferrand,

Clermont-Ferrand (63).

Autoimmune hemolytic anemia (AIHA) is diagnosed in the presence of

anemia, usually macrocytic and of variable intensity,

reticulocytosis, and a positive direct and/or indirect antiglobulin

test, after ruling out other types of hemolytic anemia. A positive

direct antiglobulin test alone is not sufficient to diagnose AIHA

and may be positive in many patients without anemia or negative in

some patients with AIHA.

AIHA may be classified into two major categories according to the

optimal temperature of antibody activity: warm-reacting

autoantibodies (usually IgG) optimal around 37 degrees C and cold-

reacting autoantibodies, optimal at 4 degrees C (usually IgM). This

classification guides the selection of tests and treatment. AIHA is

widely reported to be associated with a variety of other diseases,

although these associations are often fortuitous. A minimal set of

useful investigations is appropriate since AIHA may be secondary to

viral infections, lymphoid malignancies, or autoimmune disorders

such as lupus. Transfusion should remain rare in AHAI, but close

contact with the transfusion service is necessary if it is to

succeed.

As for many autoimmune and/or systemic diseases, numerous types of

treatment have been proposed but have not been validated in

controlled multicenter studies. These are necessary to improve the

management of these rare disorders.

PMID: 17481848 [PubMed - as supplied by publisher]