Autoimmune Hemolytic Anemia: Diagnosis and Management Approach

MBBS
1

A 52-year-old male presents with progressive fatigue, pallor, and mild jaundice. Laboratory investigations reveal a normocytic normochromic anemia, elevated lactate dehydrogenase (LDH), low haptoglobin, and indirect hyperbilirubinemia. His direct Coombs test is positive.
Discuss the pathophysiology, diagnostic approach, and management plan for this patient’s condition. How would the management differ if the patient had cold agglutinin disease instead?

2

This is autoimmune hemolytic anemia

And this could be managed by 1st line treatment of glucocorticoids and also via splenectomy, blood transfusion, immunosuppressants

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Do a C3d and IgG test.

  • If IgG+ and C3d +/- —> Think of Warm Ab Autoimmune Anaemia. Rule out possible causes like SLE, Autoimmune, Leukemias and Drugs.
  • Ig IgG - and C3d + —> Think Cold Antibody Autoimmune Anaemia or Paroxysmal Cold Hemoglobinurea. Do a DL Antibody titre (theoretical only) and if + it’s Cold Antibody Autoimmune anaemia. Rule out possible causes. Only if it’s idiopathic can it be labelled as “Cold Agglutinin Disease”
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