Autoimmune
Haemolytic Anaemia (AIHA) :
When Antibody Response
Goes Awry
Sarawak General Hospital
Haematology Unit
MO teaching
Lee Wei Sern
Leong Tze Shin
17 FEBRUARY 2023
, Outline
• Definition , Epidemiology & Pathophysiology
• Symptoms & Diagnosis, special mention on Reticulocyte Count and
Coombs test
• Warm vs Cold AIHA
• Treatment options
• Case Scenarios
, Definition
• What is Haemolysis? • What is Haemolytic
Anaemia?
Accelerated destruction of
RBC, leading to decrease
RBC production
RBC survival RBC Destruction (erythropoiesis)
(Haemolysis)
A Victor Hoffbrand MA et al. Postgraduate Haematology, Seventh Edition. CHAPTER 9. Acquired Haemolytic Anaemias Pp: 138-155. West Sussex ; Hoboken, NJ : John Wiley and Sons, 2016
, Phillips J, Henderson AC. Hemolytic Anemia: Evaluation and
Differential Diagnosis. Am Fam Physician. 2018;98(6):354-361
Anaemia > Haemolysis ?
Red flags:
• Hb<6
Stable/Life-threatening ? • Haemodynamic
instability
• Renal failure
Comprehensive Hx & Examination • Ill-looking
Haemolytic marker:
• FBC/Indirect bilirubin/LDH/Haptaglobin
DAT positive • Reticulocyte count DAT negative
• Peripheral Blood Film (causes)
• Coombs test (DAT/IAT)
AIHA Further Evaluation:
Further Evaluation: • Bite cells>> G6PD; Drugs
• Infection: HBV/HCV/HIV/Covid/ Mycoplasma • Schistocytes>>MAHA/TTP: ADAMTS13
• Autoimmune: ANA,dsDNA • Irregularly contracted cells>> Hb/DNA analysis
• Drugs • Spherocytes: Family Hx >> Osmotic fragility test
• Malignancy: Tumour markers/CXR/USG/CT • PNH >> PNH clone immunophenotyping
• Bone marrow – in relapse cases or clinical suspicion
Haemolytic Anaemia (AIHA) :
When Antibody Response
Goes Awry
Sarawak General Hospital
Haematology Unit
MO teaching
Lee Wei Sern
Leong Tze Shin
17 FEBRUARY 2023
, Outline
• Definition , Epidemiology & Pathophysiology
• Symptoms & Diagnosis, special mention on Reticulocyte Count and
Coombs test
• Warm vs Cold AIHA
• Treatment options
• Case Scenarios
, Definition
• What is Haemolysis? • What is Haemolytic
Anaemia?
Accelerated destruction of
RBC, leading to decrease
RBC production
RBC survival RBC Destruction (erythropoiesis)
(Haemolysis)
A Victor Hoffbrand MA et al. Postgraduate Haematology, Seventh Edition. CHAPTER 9. Acquired Haemolytic Anaemias Pp: 138-155. West Sussex ; Hoboken, NJ : John Wiley and Sons, 2016
, Phillips J, Henderson AC. Hemolytic Anemia: Evaluation and
Differential Diagnosis. Am Fam Physician. 2018;98(6):354-361
Anaemia > Haemolysis ?
Red flags:
• Hb<6
Stable/Life-threatening ? • Haemodynamic
instability
• Renal failure
Comprehensive Hx & Examination • Ill-looking
Haemolytic marker:
• FBC/Indirect bilirubin/LDH/Haptaglobin
DAT positive • Reticulocyte count DAT negative
• Peripheral Blood Film (causes)
• Coombs test (DAT/IAT)
AIHA Further Evaluation:
Further Evaluation: • Bite cells>> G6PD; Drugs
• Infection: HBV/HCV/HIV/Covid/ Mycoplasma • Schistocytes>>MAHA/TTP: ADAMTS13
• Autoimmune: ANA,dsDNA • Irregularly contracted cells>> Hb/DNA analysis
• Drugs • Spherocytes: Family Hx >> Osmotic fragility test
• Malignancy: Tumour markers/CXR/USG/CT • PNH >> PNH clone immunophenotyping
• Bone marrow – in relapse cases or clinical suspicion
