Autoimmune Hemolytic Anemias: Classifications, Pathophysiology, Diagnoses and Management

Area of Science:

• Hematology
• Immunology
• Internal Medicine

Background:

• Autoimmune hemolytic anemias (AIHAs) are characterized by autoantibodies targeting red blood cells (RBCs).
• AIHAs can be primary or secondary to other conditions, presenting diverse clinical and serological features.
• Classification relies on direct antiglobulin test (DAT) findings, differentiating warm, cold, mixed, and other AIHA subtypes.

Purpose of the Study:

• To provide a comprehensive review of various autoimmune hemolytic anemias.
• To detail the diagnosis, pathophysiology, and treatment modalities for each AIHA category.
• To elucidate the role of autoantibodies and complement in RBC destruction.

Main Methods:

• Review of existing literature on AIHA classification and management.
• Analysis of diagnostic criteria, including direct antiglobulin test (DAT) results.
• Discussion of therapeutic strategies, encompassing corticosteroids, immunosuppressants, and targeted therapies.

Main Results:

• AIHAs are categorized into warm-antibody, cold-antibody, mixed, paroxysmal cold hemoglobinuria, DAT-negative, drug-induced, and passenger lymphocyte syndrome.
• Treatment strategies vary based on AIHA type, ranging from glucocorticoids to monoclonal antibodies targeting specific immune components.
• Understanding autoantibody specificities and DAT profiles is crucial for accurate diagnosis and effective management.

Conclusions:

• Accurate classification of AIHA subtypes based on serological findings is essential for guiding treatment.
• Therapeutic options are evolving, with increasing use of targeted therapies like monoclonal antibodies.
• This review offers a detailed overview for clinicians managing patients with AIHA.