title: Clinical characteristics and long-term outcomes of warm-type autoimmune hemolytic anemia.
abstract: OBJECTIVE
  To study the clinical manifestations, outcomes, and survival of warm-type autoimmune hemolytic anemia (AIHA) patients.
  
  
  METHODS
  This study was a retrospective single-center study from 2002 to 2013. Clinical data of AIHA patients were reviewed and analyzed.
  
  
  RESULTS
  One hundred and one patients were included, of whom 77% were female with a median age of 43 years. Primary AIHA was found in 61% of the patients. The secondary causes were systemic lupus erythematosus (SLE) (64%), solid malignancies (13%), lymphomas (10%), drugs (8%), and infections (5%). Most patients (96%) responded to steroids, which were not different between primary and secondary AIHA. Second-line treatments were required in 33 patients (33%). The indications were steroid dependence (58%), relapse (30%), and others (12%). The most common second-line treatment was cyclophosphamide (52%). The response rate for second-line treatments was 93%. Relapse occurred in 50 patients (50%) in which 58% occurred more than 3 years after diagnosis. The SLE patients relapsed and received second-line therapy more than the non-SLE group (P < 0.001). At the median 53-month follow-up, the overall survival (OS) was 84%. The independent risk factors for OS were age more than 50 years and malignancy. Sepsis was the most common cause of death.
  
  
  CONCLUSIONS
  AIHA has a good prognosis and long-term survival especially in young patients without malignancy. Most patients have responded initially to steroids and have a high response rate to second-line therapy. Carefully adjusted and rapid taper of immunosuppressant is necessary to avoid sepsis complications.
authors.affiliation: a Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Ekarat
authors.initials: E
authors.lastname: Rattarittamrong
authors.affiliation: b Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Prot
authors.initials: P
authors.lastname: Eiamprapai
authors.affiliation: a Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Adisak
authors.initials: A
authors.lastname: Tantiworawit
authors.affiliation: a Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Thanawat
authors.initials: T
authors.lastname: Rattanathammethee
authors.affiliation: a Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Sasinee
authors.initials: S
authors.lastname: Hantrakool
authors.affiliation: a Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Chatree
authors.initials: C
authors.lastname: Chai-Adisaksopha
authors.affiliation: a Division of Hematology, Department of Internal Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Lalita
authors.initials: L
authors.lastname: Norasetthada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Autoimmune hemolytic anemia (AIHA); Primary autoimmune hemolytic anemia; Secondary autoimmune hemolytic anemia; Warm-type autoimmune hemolytic anemia