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Description

A rare and challenging hematologic disorder called autoimmune hemolytic anemia (AIHA) causes the immune system of the individual to attack red blood cells (RBCs). In AIHA, the human immune system misinterprets its own RBCs as foreign and mounts an immunological attack, which results in their destruction. Anemia is brought on by the body’s failure to keep enough normal red blood cells in circulation due to this immune-mediated RBC destruction.

According to the ideal temperature for antibody operation, AIHA can be divided into two categories, including: –

Warm Antibody AIHA: In around 70–80% of instances, this kind of AIHA is the more prevalent one. Warm autoantibodies are autoantibodies that are generated by the warm antibody AIHA and bound to RBCs. Most of the RBCs that are destroyed by these autoantibodies are destroyed in the spleen, where they are most active (37°C). Anemia is caused by the shortening of red blood cells’ lifespan as a result of RBC destruction.

Cold Antibody AIHA: Autoantibodies known as cold hemolysins or cold agglutinins have been generated by cold antibody AIHA. These autoantibodies react best in colder climates and often destroy RBCs that regulate peripheral circulation, especially in the extremities. These autoantibodies bind to RBCs and cause their destruction when exposed to cold temperatures. Cold antibody AIHA is less frequent than warm antibody AIHA and is frequently linked to underlying diseases like infections or lymphoproliferative diseases.

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Autoimmune Hemolytic Anemia (AIHA): Description, Causes, and Treatment Protocol is an original (HealthXWire) article.

Possible Causes

Autoimmune hemolytic anemia (AIHA) frequently has an undetermined, specific cause. The emergence of AIHA, nevertheless, has been linked to a number of circumstances. These potential causes include: –

Underlying Autoimmune Conditions: People who also have rheumatoid arthritis, systemic lupus erythematosus (SLE), or primary immunodeficiency issues may also develop AIHA. The underlying autoimmune conditions caused immune system dysregulation and the creation of autoantibodies that assault red blood cells.

Genetic Predisposition: Some genetic differences have been found in people with AIHA, suggesting that there might be a hereditary component to the disease. These alterations may have an impact on the immune system’s reaction and increase the risk of autoimmune illnesses, such as AIHA.

Medications: AIHA has been linked to the creation of particular drugs. There have been reports of medications like cephalosporins, quinidine, penicillin, and several NSAIDs causing AIHA in people who are vulnerable. Red blood cells may be destroyed as a result of an immunological reaction brought on by these drugs.

Infections: Infections, especially bacterial and viral infections, have been linked to the emergence of AIHA. Immune system stimulation from infections may result in an autoimmune reaction that targets red blood cells. A number of viruses and bacterial illnesses, including Helicobacter pylori, the cytomegalovirus, Mycoplasma pneumoniae, and the Epstein-Barr virus, have been linked to AIHA.

Unknown Triggers: AIHA may occasionally develop with no apparent cause or trigger which is also known as idiopathic AIHA. In these circumstances, the growth of AIHA is thought to be influenced by a mix of environmental, genetic, and immunological variables.

Malignancies: AIHA may manifest as a paraneoplastic condition, which means it is linked to an underlying cancer. AIHA has been associated with a number of malignancies, including chronic lymphocytic leukemia, lymphomas, and solid tumors. Although the exact mechanisms through which malignancies cause AIHA remain unidentified, it is believed that cancer cells or the byproducts they produce cause an immune reaction that targets red blood cells.

Exacerbating and Mitigating Factors

The following are the factors that make AIHA worse: –

Medications: A number of drugs have been linked to the onset or worsening of AIHA. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as penicillin, have been documented to cause hemolysis in sensitive people. To detect potential triggers while making the appropriate adjustments, it is essential to let healthcare providers know about any drugs that are being taken.

Cold Temperatures: Red blood cells are destroyed in reaction to cold temperatures by the cold antibody AIHA. People with this kind of AIHA may have hemolysis after being exposed to cold temperatures or settings. Hence, these people should stay out of the cold for short periods of time and should dress warmly.

Underlying Autoimmune Conditions: AIHA has been linked to autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus (SLE). These circumstances may make AIHA symptoms worse and make therapy more challenging. To mitigate the effect of AIHA, the underlying autoimmune disorder must be managed.

Infections: AIHA has been associated with the onset or aggravation of bacterial and viral illnesses, including Mycoplasma pneumoniae, Epstein-Barr virus, and HIV. Immune system stimulation from infections may result in an autoimmune reaction that targets red blood cells. AIHA symptoms could be lessened with prompt infection management and treatment.

Following are some of the mitigating factors for AIHA: –

Regular Physical Activity: Regular physical activity helps strengthen the immune system and general health, as long as it is tolerated. To choose the best workout regimens, we should take unique talents and any potential limits into account. It is also vital to speak with a healthcare practitioner.

Avoiding Triggers: Individual triggers can be identified and avoided to lessen the intensity of AIHA symptoms. This can entail avoiding cold climates, stopping drugs that have been linked to triggers, and taking measures to avoid infections.

Well-Balanced Diet: A good diet is crucial for maintaining general health, which includes the generation of strong red blood cells. Lean proteins, whole grains, a variety of fruits and vegetables, and enough water, can boost immunological health and help maintain optimal nutrition.

Maintaining a Strong Immune System: Taking measures to support a strong immune system will help you manage AIHA. This involves practicing excellent hygiene, getting enough sleep, controlling chronic ailments, and, whenever possible, avoiding contact with people who are contagious.

Stress Management: The symptoms of AIHA may be made worse by ongoing stress. Reducing stress levels and promoting general well-being can be achieved by putting stress management strategies into practice, including relaxation techniques, yoga, meditation, and relaxation exercises.

Standard Treatment Protocol

The main objectives of AIHA treatment are symptom relief and suppression of the immune system’s invasion of red blood cells. Common treatment regimens usually include the following: –

Immunosuppressive Drugs: Additional immunosuppressive drugs may be used when corticosteroids alone become insufficient or poorly tolerated. These medications, such as mycophenolate mofetil, azathioprine, and cyclosporine, function by further weakening the body’s immune system and lowering the autoimmune reaction.

Corticosteroids: AIHA is frequently treated in the first instance with corticosteroids like prednisone. By inhibiting the immune system’s reaction, they lessen red blood cell apoptosis. Prednisone is typically started in large doses and then gradually tapered as the situation improves.

Splenectomy: When AIHA remains unresponsive to other treatments, splenectomy, or surgical elimination of the spleen, may be an option in some circumstances. By eliminating the spleen, hemolysis can be reduced since the spleen contributes to the breakdown of the antibody-covered red blood cells.

Rituximab: Rituximab remains a monoclonal antibody targeting and depleting B lymphocytes specifically because they are involved in the development of autoantibodies in AIHA. When previous therapies have failed or there is refractory AIHA, it is frequently utilized as adjuvant therapy. Rituximab has demonstrated promise in raising hemoglobin levels and minimizing the requirement for corticosteroids.

Treatment Options

To increase the effectiveness of standard therapy for AIHA, different adjunct therapies might be investigated along with traditional treatment procedures. Among them are the following: –

Nutritional Supplements: These include: –

• Iron Supplements

AIHA may trigger iron deficiency anemia because it destroys more red blood cells. To replace iron stores and maintain the generation of red blood cells, iron supplementation might be required.

• Vitamin B12 and Folic Acid

In cases when AIHA is linked to vitamin B12 or folate insufficiency, these supplements can be administered to enhance red blood cell synthesis and avoid megaloblastic anemia.

Over-the-Counter Formulations: These include: –

• Pain Relievers

Acetaminophen and other over-the-counter painkillers can be used to address AIHA-related pain. Before using any over-the-counter medications, it is important to see a healthcare professional to avoid any potential interactions with prescribed therapy.

Natural and Herbal Remedies: Despite the paucity of research on natural and herbal treatments for AIHA, some may be useful as adjuvant therapies. Natural treatments that have been researched include: –

• Turmeric

The key ingredient in turmeric, curcumin, has been shown to have immunomodulatory and anti-inflammatory properties. By lowering inflammation and regulating the immunological response, it might help manage AIHA.

• Astragalus

Due to its immunomodulatory qualities, astragalus has been employed in conventional Chinese medicine. It might support healthy immunological function in general and control immune responses.

Nevertheless, it is crucial to remember that any adjunct therapies ought to be continually addressed and overseen by a healthcare practitioner. These therapies may have varying degrees of success depending on the patient, thus each patient’s requirements and responses must be taken into account when choosing which ones to utilize.

Conclusion

Autoimmune hemolytic anemia (AIHA) is a hematologic disorder that causes anemia due to red blood cells being attacked by the immune system. Managing AIHA requires a multifaceted approach aimed at suppressing the immune response while addressing the anemia and its underlying cause. This can be a bit complicated as the underlying cause may stem from different roots. Standard treatment typically involves immunosuppressive medications, such as corticosteroids, or rituximab, to control the autoimmune response.

In severe cases, splenectomy may be considered to eliminate the organ that breakdown the antibody-covered red blood cells. Close monitoring of blood parameters and regular follow-ups with hematologists are crucial in tracking disease progression. Patients with AIHA may also benefit from adopting a healthy lifestyle, ensuring proper nutrition, and avoiding triggers that may worsen the condition.

Additional resources for further reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246027/

https://www.childrenshospital.org/conditions/autoimmune-hemolytic-anemia

https://www.medicalnewstoday.com/articles/312508

https://my.clevelandclinic.org/health/diseases/22349-autoimmune-hemolytic-anemia

Important Note: The information contained in this article is for general informational purposes only, and should not be construed as health or medical advice, nor is it intended to diagnose, prevent, treat, or cure any disease or health condition. Before embarking on any diet, fitness regimen, or program of nutritional supplementation, it is advisable to consult your healthcare professional in order to determine its safety and probable efficacy in terms of your individual state of health.

Regarding Nutritional Supplements Or Other Non-Prescription Health Products: If any nutritional supplements or other non-prescription health products are mentioned in the foregoing article, any claims or statements made about them have not been evaluated by the U.S. Food and Drug Administration, and such nutritional supplements or other health products are not intended to diagnose, treat, cure, or prevent any disease.