Treatment of autoimmune hemolytic anemia

The good thing is that, if symptoms are mild or if destruction of red blood cells seems to be slowing on its own, no treatment will be needed.

Corticosteroids
If red blood cell destruction is worsening, some corticosteroid drugs such as Prednisone are usually the first choice for treatment. They should suppress the immune system which is usually overactive. High doses should be used at first and then a gradual decreasing of the dose should follow over many weeks or months.

Surgical solutions
When people do not respond to corticosteroids, a surgery to remove the spleen is often the next choice of treatment. This operation is called splenectomy. Splenectomy is not recommended in hemolytic disorders such as cold agglutinin hemolytic anaemia.

Immunosuppressive drugs
When destruction of red blood cells persists after removal of the spleen or when surgery cannot be performed, immunosuppressive drugs, such as Cyclophosphamide or Azathioprine, are used to suppress the immune system response.

Plasmapheresis
Plasmapheresis is a specific procedure which involves filtering blood to remove antibodies. It is occasionally very helpful when other treatments fail.

Transfusion therapy
When red blood cell destruction is severe, blood transfusions are needed. The problem is that they do not treat the cause of the anemia and provide only temporary relief. In these disorders, type matching and cross-matching may be very difficult. The risk of acute hemolysis of transfused blood is high, but the degree is dependent on the rate of infusion. 

Iron therapy
Studies have shown that this is indicated for patients with severe intravascular hemolysis in which persistent haemoglobinuria has caused substantial iron loss.

However, since iron stores increase in hemolysis, iron administration is generally contraindicated in hemolytic disorders.

Possible complications

• Anaemia: high output cardiac failure.
• Jaundice: increased unconjugated bilirubin.
• In intravascular hemolysis, iron deficiency due to chronic haemoglobinuria can exacerbate anaemia and weakness.

Tips for people with this disorder

Diet tips
Fava beans can cause severe hemolysis in certain patients with this disorder and thus eating dishes with fava beans shoud be avoided.

Medications
Medications and chemicals that should be avoided are:

• Acetanilide
• Furazolidone
• Isobutyl nitrite
• Nalidixic acid
• Naphthalene
• Niridazole