Diagnosis

• Spherocytes on peripheral blood film.

• Reticulocytes are 44.

• Neutrophilia common.

• RBC coated with IgG, complement or both (detect using DAT).

• Autoantibody—often pan-reacting but specificity in 10-15% (Rh, mainly anti-e, anti-D or anti-c).

• Serum haptoglobin 5.

• Exclude underlying lymphoma (BM, blood and marrow cell markers). 117

• Autoimmune profile—to exclude SLE or other connective tissue disorder.

Treatment

Prednisolone 1mg/kg/d PO tailing off after response noted (usually 1-2 weeks). If no response consider immunosuppression e.g. azathioprine (suitable for elderly but not younger patients—risk of 2° leukaemia) or cyclophosphamide. Splenectomy should be considered in selected cases. iVlg (0.4g/kg/d for 5d) useful in refractory cases, or where rapid response required. Rituximab (anti-CD20) is emerging as a useful agent for a range of refractory autoimmune disorders, including AIHA. Regular folic acid (5mg/d) is advised.

Gehrs, B.C. & Friedberg, R.C. (2002) Autoimmune hemolytic anemia. Am J Hematol, 69, 258-271.

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