Autoimmune hemolytic anemia

Don't miss this cause of anemia in your differential in today’s episode about autoimmune hemolytic anemia! 

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.  

Key Points: 

• Autoimmune hemolytic anemia is an extravascular hemolysis 
• Symptoms can include pallor, fatigue, lightheadedness, jaundice, tachycardia, acrocyanosis, dark urine, splenomegaly, and gallstones with labs showing anemia with schistocytes, reticulocytosis, hyperbilirubinemia, elevated LDH, elevated AST, and positive Coombs testing. 
• AIHA can be triggered by infections, underlying autoimmune diseases, malignancy, immunosuppression, and medications. 
•  Treatment is steroids or rituximab for warm AIHA and avoiding the cold for cold AIHA. In refractory cases, splenectomy or stem cell transplant may be needed. Transfusions are generally not recommended due to ongoing hemolysis unless anemia is severe. 

Sources:  

• Voulgaridou A, Kalfa TA. Autoimmune Hemolytic Anemia in the Pediatric Setting. J Clin Med. 2021;10(2):216. Published 2021 Jan 9. doi:10.3390/jcm10020216 
• Noronha, Suzie A. "Acquired and congenital hemolytic anemia." Pediatrics in Review 37.6 (2016): 235-246. doi: 10.1542/pir.2015-0053