Immunohematological work‐up, severity analysis and transfusion support in autoimmune hemolytic anemia patients

Abstract

Background and ObjectiveAutoimmune haemolytic anaemia (AIHA) is a clinical condition of reduced red cell survival by binding of antibodies (IgG/IgM) to self‐antigen and classified as warm, cold or mixed type. AIHA patients frequently have sufficient severity of anaemia as to require a blood transfusion. But little is known from India about the distribution and severity of AIHA. The objective of the study was to find out the type of AIHA, severity of haemolysis and the hindrances in transfusing these patients.Materials and methodsNinety‐four cases were included in the study. All the laboratory parameters (Hb, bilirubin, LDH, reticulocyte count) were analysed from the case sheet. All the immunohaematological workup like direct antiglobulin test, antibody screening/identification, elution–adsorption and compatibility testing were performed as per the American Association of Blood Banking (AABB) methods.ResultWarm AIHA was a more common type (61·4%) followed by mixed (23·7%) and cold type (14·9%). Fifty‐three (56%) cases were secondary AIHA. Females (68%) were more affected than males. The severity of haemolysis was found to be a significant correlation with the strength of DAT only, not with gender, type of AIHA or autoagglutinin. Thirty‐eight cases of AIHA required transfusion support, and best‐match blood units were issued to fourteen cases.ConclusionIn this region, the mixed type is more common after warm type and presented with very severe haemolysis. DAT strength directly related to the severity of haemolysis. AIHA patients with underlying alloantibody could be transfused corresponding antigen‐negative best‐match unit.