AUTOIMMUNE HEMOLYTIC ANEMIA (AIHA)

A HEMATOLOGIC PERSPECTIVE AT A TERTIARY CARE HOSPITAL

Abstract

Objectives: Autoimmune hemolytic anemia (AIHA)- an immunological disease
resulting from red cell hemolysis caused by circulating autoantibodies against antigens on red
cell membrane. Positive direct antiglobulin test (DAT) always exist in association with AIHA
and form basis for its serologic diagnosis. The objective of our study was to determine clinical
presentation and etiological pattern in autoimmune hemolytic anemia at a tertiary care hospital.
Study Design: Descriptive, cross-sectional study. Setting: Medical unit I of Liaquat University
Hospital Jamshoro / Hyderabad. Period: 1st January 2010 to 30th June 2010. Patients and
Methods: We enrolled 125 patients of either sex and ages from 13 to 81 years for evaluation
of possible AIHA. We screened patients by performing direct and indirect antiglobulin tests
(DAT and IAT) and cold agglutinin titre (CAT) levels. Pregnant women or those with history
of blood transfusion in previous three months, DAT positive patients due to Rh and ABO
incompatibilities in neonates and IAT positives cases in Rh-negative pregnant women were
excluded. Results: We evaluated 125 patients who were DAT positive autoimmune hemolytic
anemia. About 93(74.4%) were females and 32(25.6%) males with female to male ratio of
2.9:1. The mean age of our patients was SD ± 36.73 ± 9.32 years. Our patients commonly
presented, generalized weakness in 33(26.4%), pallor of face and extremities in 22(17.6%)
and breathlessness in 20(16%) respectively. On clinical examination, moderate to severe
anemia was noted in 100(80%), splenomegaly in 40(32%), hepatosplenomegaly in 28 (22.4%)
and no visceromegaly in 30(24%) of our cases. We found 35(28%) with primary and 90(72%)
patients due to secondary causes of AIHA. The connective tissue disorders, renal failure and
hematological disorders were common causes of secondary AIHA in this study. Conclusion:
Our study showed females in their thirties presented with generalized weakness, pallor of face
and extremities and breathlessness. Majority had secondary AIHA due to consecutive tissue
disorders, renal failure and hematological disorders as underlying causes. Doctors must be
cautious regarding whole blood transfusion as means for treating mild to moderate anemia.