Learn about Autoimmune Hemolytic Anemia, a blood disorder that destroys blood within your body.

Do you also feel tired all the time? Do you get dizzy even after walking for a while? Does your skin sometimes change color and look yellow? These can be signs of a common anemia. But sometimes there's a more complicated story behind it. It's a rare condition where your body's own defense system starts a war against your own blood cells. That's what we're talking about today.

What is Autoimmune Hemolytic Anemia (AIHA)?

Simply put, Autoimmune Hemolytic Anemia (AIHA) is a condition in which our body's immune system mistakenly attacks and destroys our own healthy red blood cells.

Think about it, our red blood cells are tiny vehicles that carry oxygen throughout the body. They are produced in a factory called bone marrow inside our bones. On average, a red blood cell lives for about 120 days.

But in a person with AIHA, the immune system, which is like a body's defense system, sees these red blood cells as enemy cells. Then, these defense systems, that is, antibodies, capture and destroy these red blood cells. The rate of this destruction is much faster than the bone marrow can make new red blood cells. Sometimes, a cell that is supposed to live for 120 days is destroyed in just a few days. So, the body does not get the necessary amount of oxygen and symptoms such as fatigue and weakness begin to appear.

What are the main types of AIHA?

AIHA is mainly divided into two types, depending on how the body reacts to temperature.

• Warm Autoimmune Hemolytic Anemia: This is the most common type. In this, the immune system destroys red blood cells at or above normal body temperature. This is caused by a specific type of antibody called IgG.
• Cold Autoimmune Hemolytic Anemia (Cold Agglutinin Disease - CAD): This is a very rare type. In this, the red blood cells are destroyed when the body is exposed to cold. Usually at temperatures as low as 3-4 degrees Celsius. This is caused by a type of antibody called IgM.

What are the symptoms of this disease?

Many of the symptoms of AIHA are similar to those of common anemia. Some people may not have any symptoms at all.

What causes AIHA?

Sometimes no specific cause can be found. We call this Primary AIHA. But more often it can be caused by another medical condition or medication (Secondary AIHA).

There are several main reasons:

• Other autoimmune diseases: People with other autoimmune diseases, such as lupus, are at risk of developing AIHA.
• Certain types of cancer: especially blood-related cancers such as (Chronic Lymphocytic Leukemia) and (Non-Hodgkin Lymphoma) .
• Viral and bacterial infections: Infections such as Epstein-Barr virus (the virus that causes mononucleosis, which is like a cold), Cytomegalovirus , HIV , and Mycoplasma pneumoniae .
• Certain medications: Some antibiotics (e.g., penicillin) and other medications can also cause this condition. Therefore, it is very important to tell your doctor about all medications you are taking.

How do you know if you have AIHA?

If you have these symptoms, be sure to see your doctor . He or she will ask you about your symptoms, the medications you are taking, and examine you. If necessary, they will refer you to a hematologist.

Several blood tests are mainly performed to confirm AIHA.

• Complete Blood Count (CBC): This checks your red blood cell, white blood cell, and platelet counts. A low red blood cell count is a sign of anemia.
• Peripheral Smear: A blood sample is examined under a microscope to see the shape of the red blood cells and whether they are damaged.
• Reticulocyte Count: This measures the number of immature red blood cells being produced by the bone marrow. If this number is high, it means that the bone marrow is working too hard to make new cells to replace the ones that are being destroyed.
• Coombs' Test: This is the most important test for diagnosing AIHA. It can determine whether your body is producing antibodies against red blood cells.
• Other tests: In addition, tests such as Bilirubin and Haptoglobin can also be performed.

What are the treatments for AIHA?

If your condition is not severe, you may not need treatment. However, you should be under the constant supervision of a doctor. If there are symptoms or if the anemia is severe, treatment will be started.

• Steroids: Steroids, such as prednisolone, are the first line of treatment. These suppress the overactive immune system and stop the destruction of red blood cells.
• Other drugs that control the immune system (Immunosuppressants): If the disease does not respond to steroids, drugs such as Rituximab and Azathioprine are used.
• Splenectomy: In cases where medication is not effective, especially in warm AIHA, the spleen, which is the site of most red blood cell destruction, is surgically removed.
• Blood Transfusion: If the anemia is very severe and life-threatening, a blood transfusion may be necessary.
• Vitamins and nutritional supplements: Your doctor may recommend things like folic acid, which is needed to make red blood cells. Never take any vitamins without consulting your doctor.

Special advice for those with Cold AIHA

If you have a cold-sensitive type, it is extremely important to protect yourself from the cold .

• Wear gloves when taking things out of the fridge or freezer.
• When going out on cold days, dress well, wear a hat, and a muffler.
• Don't turn the AC down too low at home.
• Before getting into the car on a cold day, start it for a while and let the inside of the car warm up.

What complications can occur if left untreated?

If AIHA is not controlled, serious complications can occur.

• Blood Clots: There is a high risk of blood clots, especially in the legs and lungs. A blood clot in the lungs (Pulmonary Embolism) can be life-threatening.
• Heart disease: Long-term anemia can weaken the heart as the heart has to work harder.
• Kidney damage: Excessive destruction of red blood cells can cause kidney damage.

Autoimmune Hemolytic Anemia, AIHA, anemia, red blood cells, immune system, Coombs test, symptoms, treatment