Autoimmune hemolytic anemia is a disorder that occurs in the body when there is a malfunction in the immune system. The immune system produces auto antibodies that attack the red blood cells, making them burst and in turn making the plasma levels of the body to go down (Melve et al, 2004). The effects may occur after a few hours or it could take up to few days before it is detected. There are “two main types of this anemia; the warm antibody hemolytic anemia and the cold antibody hemolytic anemia” (Lechner & Jager, 2012). Knowing the type of AIHA is important as it helps to identify the best donor.
The real cause of the disorder is not certain, however; it can be detected by an increase in auto antibodies that are attached to the red blood cells, or they may be found in the liquid portion of the blood. A decreased amount of red blood cells could also be an indicator (Melve et al, 2004). Therefore, the treatment may involve blood transfusion and one has to find out the compatibility of the blood before it is done. This type of anemia is common in women.
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A person suffering from autoimmune hemolytic anemia (AIHA) has the symptoms of a person with anemia, but in the case of AIHA, there is a massive destruction of the RBC’s. In severe cases, a blood transfusion is needed. Furthermore, the clinician who is in charge of such a patient should be conscious of compatibility tests to be done to match the donor’s blood with that of the patient. The auto antibodies in the blood are the chief determinants as to whether the blood is compatible or not (Lechner & Jager, 2012). The alloantibodies present in the red blood cells should be determined since they also affect the compatibility.
There are various indicators of a person who is suffering from AIHA. The person may have high levels of bilirubin (a blood protein), significantly reduced levels of serum, reduction of hemoglobin levels and the production of red blood cells also goes up, a condition known as reticulosis (Lechner & Jager, 2012). People suffering from sickle cell disease are likely to suffer from AIHA. Moreover, severe cases may result to jaundice and onset of confusion. The patient may feel weak and dizzy and lose consciousness.
It is difficult to transfuse blood to a person who is suffering from AIHA. They have auto antibodies that react with almost all the RBC in the blood regardless of the blood type. One must also consider the type of AIHA, whether it is warm or cold (Garratty, 1998). The donor should have RBC’s that are resistant to the auto antibodies that illicit hemolytic reaction in the patient. There are different approaches to deal with each type of AIHA. In warm type of AIHA: the auto antibodies destroy the RBC’s at normal body temperatures (37 degrees Celsius) and above. In the cold type, which is less common, the auto antibodies are active at temperatures below the normal body temperature (Reardon & Marques, 2006).
Care should be taken when transfusing blood to an AIHA patient to avoid over transfusion. In the event that a lot of blood is suddenly released into the system of a person with AIHA, the presence of foreign RBC’s may trigger more rapid hemolytic reactions thus worsening the situation. Also, blood should be released in bits to make the body slowly familiar with it until it attains the desired level where effects are less, and the blood is not considered as foreign (Garratty, 1998).
Auto antibodies mask the availability of alloantibodies in the blood, making transfusion increasingly difficult. Alloantibodies that are not detected may increase hemolytic reactions in the body giving a fake illusion of severe AIHA (Reardon & Marques, 2006). Alloantibodies may be present in the blood as a result of previous transfusions or pregnancies; this may cause a reaction in the occurrence of hemolytic transfusion (Petz & Garratty, 2004).These alloantibodies increase damage on the RBC. The auto antibodies that cause AIHA are different and cannot be attributed to a single type. A person who is in urgent need of blood should not be denied, especially, if the hemoglobin level is below 5g/dl (Handin, Lux & Stossel, 2002). Considerations should be made for persons above 50 years old who are suffering from cardiovascular diseases.
The presence of alloantibodies is detected by examining the patient’s blood with known phenotypes of RBC to see whether a reaction occurs. For example, serum containing Jk (a+) RBC’s does not trigger a reaction with Jk (a-) RBC’s. This does not apply in cases where the patient has warm antibody AIHA; it reacts with all the RBC’s present thus masking the effect of the good phenotype (Petz, 1996). Moreover, the donor’s RBC phenotype can also be matched extensively with that of the patient to determine their compatibility. The patient’s serum can be examined occasionally against the RBC phenotype, and the donor’s serum diluted before the test is done (Lawrence & Pet, 2004). This is an effort to make the compatibility test faster and easier.
There are three main methods used to identify the type of auto antibodies; the warm auto adsorption, adsorption with enzyme that has been treated and dilution of the patient’s serum. These are the methods that are commonly used in approaching a patient with warm hemolytic AIHA (Garratty, 1993). Hence it is easier to treat cold antibody hemolytic AIHA, cold adsorptions are used instead of the hot adsorptions. It is less labor demanding, and procedures that are used are not as complicated as those involved in the warm type (Lawrence & Pet, 2004).
There are two main problems that are encountered while checking the compatibility of the blood; when cross matching and typing blood before a transfusion. The appropriate procedure should be employed to avoid getting the wrong results (Garratty, 1993). Blood that is rare should be banked and used within six months instead of discarding it.
A person who is suspected to have AIHA should have the compatibility tests done within six hours in order the transfusion process can begin. The type of AIHA should be determined before the transfusion. Yunis and Brigges (1996) suggest that the urgency of the transfusion should be indicating so that the treatment starts immediately. Therefore, there should be a direct communication between the lab technician and the clinician to facilitate the transfusion process (Petz, 2004).
In conclusion, it is evident that the cause of AIHA is not certain. It is a condition that affects the RBC’s of the body causing them to burst. Scientists have not established the real cause of this disorder, however, it can be detected by an increase in auto antibodies that are attached to the red blood cells, or they may be found in the liquid portion of the blood. There are two types, the cold antibody AIHA and the warm antibody AHIA. Consideration should be done when treating each type (Garratty, 1998). This type of anemia is most common in women as opposed to men and children. Compatibility tests are done to determine the presence of auto antibodies and the type of alloantibodies that are present. Mistakes can be made during this procedure and maximum care should then be applied. It is easier to treat the cold antibody AIHA, as opposed to the warm type. Samples of serum are matched on the red cell panel to ascertain their compatibility. Lastly, persons above age 50 suffering from cardiovascular disease should have an urgent blood transfusion (Garratty, 2010).
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