title: How I treat autoimmune hemolytic anemia.
abstract: Autoimmune hemolytic anemia (AIHA) is an uncommon entity that presents diagnostic, prognostic, and therapeutic dilemmas despite being a well-recognized entity for over 150 years. This is because of significant differences in the rates of hemolysis and associated diseases and because there is considerable clinical heterogeneity. In addition, there is a lack of clinical trials required to refine and update standardized and evidence-based therapeutic approaches. To aid the clinician in AIHA management, we present four vignettes that represent and highlight distinct clinical presentations with separate diagnostic and therapeutic pathways that we use in our clinical practice setting. We also review the parameters present in diagnostic testing that allow for prognostic insight and present algorithms for both diagnosis and treatment of the AIHA patient in diverse situations. This is done in the hope that this review may offer guidance in regard to personalized therapy recommendations. A section is included for the diagnosis of suspected AIHA with negative test results, a relatively infrequent but challenging situation, in order to assist in the overall evaluation spectrum for these patients.
authors.affiliation: Division of Hematology, Department of Medicine, and.
authors.forename: Ronald S
authors.identifier: 0000-0002-8284-3495
authors.initials: RS
authors.lastname: Go
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Jeffrey L
authors.identifier: 0000-0001-8654-3732
authors.initials: JL
authors.lastname: Winters
authors.affiliation: Division of Hematology, Department of Medicine, and.
authors.forename: Neil E
authors.identifier: 0000-0002-5951-5055
authors.initials: NE
authors.lastname: Kay
mesh_terms: D000368:Aged; D000465:Algorithms; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D003298:Coombs Test; D017707:Erythrocyte Transfusion; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications; D008297:Male; D008875:Middle Aged; D000069283:Rituximab / Q000627:therapeutic use; D012698:Serologic Tests / Q000379:methods; D013156:Splenectomy; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D005938:Glucocorticoids; D000069283:Rituximab; D014740:Vidarabine; C024352:fludarabine