General Practice 2022

Hemolítica anemia: what é, main symptoms and treatment

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Hemolítica anemia: what é, main symptoms and treatment
Hemolítica anemia: what é, main symptoms and treatment

Autoimmune hemolytic anemia, also known by the acronym AHAI, is a disease characterized by the production of antibodies that react against red blood cells, destroying them and producing anemia, with symptoms such as tiredness, paleness, dizziness, skin and yellow eyes and malaise

This type of anemia can affect anyone, but it is more common in young adults. Although its cause is not always clear, it can arise from dysregulation of the immune system after an infection, the presence of another autoimmune disease, the use of certain drugs or even cancer.

Autoimmune hemolytic anemia is not always curable, however, it is treated mainly with the use of medications to regulate the immune system, such as corticosteroids and immunosuppressants.In some cases, removal of the spleen, called splenectomy, may be indicated, as this is where part of the red blood cells are destroyed.

Main symptoms

Symptoms of autoimmune hemolytic anemia include:

  • Weakness;
  • Feeling faint;
  • Pale;
  • Lack of appetite;
  • Dizziness;
  • Tiredness;
  • Sleep;
  • Indisposition;
  • Headache;
  • Weak nails;
  • Dry skin;
  • Hair loss;
  • Shortness of breath;
  • Pale in the mucous membranes of the eyes and mouth;
  • Jaundice.

These symptoms are very similar to those caused by other types of anemia, so it is necessary for the doctor to request tests that can help to identify the exact cause, such as a low dose of red blood cells, a high count of reticulocytes, which are immature red blood cells, in addition to immunological tests.

Check out how to differentiate between causes of anemia.

What are the causes

The cause of autoimmune hemolytic anemia is not always identified, however, in many cases it can be secondary to the presence of other autoimmune diseases, such as lupus and rheumatoid arthritis, cancer, such as lymphomas or leukemias, or due to a reaction to medications such as Levodopa, Methyldopa, anti-inflammatories and certain antibiotics.

It can also arise after infections, such as those caused by viruses such as Epstein-Barr or Parvovirus B19, or by bacteria such as Mycobacterium pneumoniae or Treponema pallidum when it causes tertiary syphilis, for example.

In about 20% of cases, autoimmune hemolytic anemia is worsened by cold, as in these cases the antibodies are activated by low temperatures, being called AHAI by cold antibodies. The other cases are called AHAI by hot antibodies, and they are the majority.

How to confirm the diagnosis

For the diagnosis of autoimmune hemolytic anemia, the tests that the doctor will order include:

  • Hemogram, to identify anemia and observe its severity;
  • Immune tests, such as the direct Coombs test, which shows the presence of antibodies bound to the surface of red blood cells. Understand what the Coombs test means;
  • Tests that prove hemolysis, such as an increase in reticulocytes in the blood, which are immature red blood cells that appear in the bloodstream in excess in case of hemolysis;
  • Indirect bilirubin measurement, which increases in cases of severe hemolysis. Find out what it is for and when the bilirubin test is indicated.

As several anemias can have similar symptoms and tests, it is very important that the doctor is able to differentiate between the different causes of anemia. Learn more about the tests at: Tests that confirm anemia.

How the treatment is done

It cannot be said that there is a cure for autoimmune hemolytic anemia, as it is common for patients with this disease to experience periods of outbreaks and improvement.

To live as long as possible in a period of remission, it is necessary to carry out the treatment that is indicated by the hematologist, made with medicines that regularize the immune system, which include corticosteroids, such as Prednisone, immunosuppressants, such as Cyclophosphamide or Cyclosporine, immunomodulators, such as human immunoglobulin or plasmapheresis, which helps to remove excess antibodies from the bloodstream, in severe cases.

Surgical removal of the spleen, called splenectomy, is an option in some cases, especially for patients who do not respond well to treatment. As the risk of infection can increase in people who have this organ removed, vaccines such as antipneumococcal and antimeningococcal are recommended.Read more about care and recovery after spleen removal.

Furthermore, the choice of treatment depends on the type of autoimmune hemolytic anemia, the symptoms presented and the severity of the disease in each person. The treatment time is variable, and in some cases it is possible to try to start withdrawing the drugs after about 6 months to evaluate the response, depending on the hematologist's guidance.

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