Autoimmune hemolytic anemia

Autoimmune hemolytic anemia is a type of hemolytic anemia caused by dysfunction of the patient's immune system, in which autoantibodies and/or complement produced by the patient adsorb onto the surface of red blood cells, leading to accelerated destruction of red blood cells. As early as 1904, Donath and Landsteiner reported that cold hemolysins could be detected in the serum of patients with paroxysmal cold hemoglobinuria, and confirmed that the antigen-antibody reaction was the cause of this disease. Autoimmune hemolytic anemia is classified primarily based on the characteristics of the autoantibodies against red blood cells, and is currently divided into three major categories: warm antibody type, cold antibody type, and mixed warm-cold antibody type. Each category has different subtypes. Clinical manifestations: In warm antibody autoimmune hemolytic anemia, the onset and disease course vary greatly. In most patients, the severity of symptoms depends on the degree of anemia, while in a minority of patients, symptoms are related to the chronic diseases associated with this condition. Common symptoms include fatigue, tiredness after exertion, dizziness, and dyspnea; a few severely affected patients may develop heart failure. In some cases, jaundice may become the patient's main symptom. Some cases present with recurrent episodes of fever and abdominal pain. Less common symptoms include precordial pain, headache, and thrombophlebitis. When hemolysis intensifies, anemia progresses rapidly, and patients may develop collapse and semicoma. In severe cases, extravascular hemolysis may occur, and hemoglobinuria may also appear. In idiopathic cases or those associated with malignant diseases or lupus erythematosus, the onset is often chronic and insidious, with gradually worsening hemolysis. Acute, fulminant, life-threatening episodes of autoimmune hemolytic anemia are often associated with acute viral infections or unknown causes, and are particularly common in children. A small number of patients with idiopathic autoimmune hemolytic anemia may also have an acute onset, but precipitating factors such as infection, trauma, surgery, pregnancy, or psychological stress are often present before onset. The disease course varies in length; patients with primary autoimmune hemolytic anemia may have a disease course lasting more than 20 years with appropriate treatment. In contrast, the disease course and changes in the hemolytic process in patients with secondary autoimmune hemolytic anemia usually depend on the underlying disease.