Hemolytic Anemia Flashcards
Which infectious etiologies should be checked in patients with evidence of AIHA?
EBV serology CMV serology HIV serology HCV and HBV serology Mycoplasma antigen
What Coomb’s Antibody test results indicate warm AIHA? Cold AIHA?
Coomb’s Testing for Warm AIHA –> IgG (+), or C3d + IgG once cold antibody has been excluded (below)
Coomb’s Testing for Cold AIHA –> C3d +/- IgG, followed up with a Direct Agglutination Test w/ Cold Antibody Titer > 1:64
Which supplement should be given in patients with AIHA?
Folic Acid, to support reticulocyte production during hemolytic course.
Is there risk for patients with hemolytic anemia to develop VTE? When is the risk max? Should you treat? With What?
Yes, VTE is seen in 20-25% of AIHA cases.
Risk is typically increased for VTE when the patient has Cold Agglutinin Disease (CAD) or when patient is actively hemolyzing.
Pts in in-patient setting should have VTE Prophylaxis
Pts in out-patient should have prophylaxis when hemolysis causes Hgb < 8.5
Tx with LMWH in both settings.
What is first line treatment for Warm AIHA? What about CAD? Why is this different?
Warm AIHA –> 1st line Tx = Steroids (1 mg/kg) +/- Rituximab
Cold AIHA (CAD) –> Rituximab + Warmed saline solutions, In-site IV warmer, keep from cold exposure.
As, CAD is less repsonsive to steroid regimens, compared to Warm AIHA.
What is 2nd line Tx for Warm AIHA? How effect is this?
IF pts not responsive to Steroids +/- Rituximab (or if Rituximab cost is issue) —> 2nd line is Splenectomy.
Approx 70% of patients will respond to splenectomy.
What treatment is required for severe Cold Agglutinin AIHA? Why not Rituximab?
Pts with severe episodes of hemolysis from CAD should be started on Plasmaphoresis (Case Report Evidence) in addition to blood transfusions.
Eculizumab has also been reported to help in cases requiring urgent treatment.
Illness Script for AIHA?
Pt with history of CLL/Rheumatoid conditions/HIV/Hepatitis presenting with dyspnea on exertion/Fatigue + Jaundice found to have with normocytic anemia (typically) with elevated LDH, decreased haptoglobin, and hemaglobinuria without presence of Urine RBCs.
