Transfusion of the Patient with Autoimmune Hemolysis

This chapter gives an overview of autoimmune hemolytic anemias (AIHAs) and their treatment strategies. The autoimmune hemolytic anemias (AIHAs) are characterized by the following two features: decreased red blood cell survival and the presence of an autoantibody directed against red blood cell antigens. The AIHAs are classified based on the characteristics of the causative antibody, including its immunoglobulin class and thermal reactivity. Warm AIHA is generally due to IgG autoantibodies. The therapeutic approaches to warm AIHA are corticosteroids, intravenous IgG, splenectomy, immunosuppressive therapy, and other forms of therapy with danazol and plasmapheresis. Cold agglutinin syndrome (CAS) can occur in either an acute or chronic form. The mainstay of treatment for patients with CAS is avoidance of cold. Occasionally, unusual patients appear to have a combination of both warm and cold AIHA, or mixed-type AIHA; these patients are treated with corticosteroid therapy. An acquired hemolytic anemia can develop in association with drugs. In treating drug-induced hemolytic anemia, the implicated drug should be discontinued immediately. Sometimes steroid therapy, supportive therapy, and transfusion therapy may be required. Red blood cell transfusion is a significant component of the supportive care for all patients with AIHA. Transfusion management is complicated for patients with AIHA, due to their serologic complexities. Thus, proper management should be implemented for the patients' safety.