Diagnóstico e tratamento da anemia hemolítica autoimune: uma minirrevisão

Abstract

Autoimmune hemolytic anemia (AIHA) is a cytopenia in which autoantibodies that bind to antigens located on the erythrocyte membrane occur, whose dominant pathophysiological mechanism is failure to maintain self-tolerance. It can be idiopathic or happen secondary to medication use, infections, other autoimmune diseases, lymphoproliferative disorders, among others. In AIHA by warm antibodies, autoantibodies react more easily at body temperature. In AIHA by cold antibodies, autoantibodies bind to erythrocytes at temperatures between 4º and 18ºC. For the diagnosis, the physical examination should be performed, as well as laboratory tests, such as blood count, reticulocyte count, lactate dehydrogenase (LDH), bilirubin and haptoglobin measurements, in addition to flow cytometry. The immunohematological diagnosis is made through the Direct Antiglobulin Test, also called the Direct Coombs. Screening for antibody-bound alloantibodies, the Enzyme Linked Immunosorbent Assay (ELISA), and the Polybrene Direct Test (TPD) may also be requested. Treatment is based on elimination of the underlying cause, if any, administration of monoclonal antibodies, immunosuppressive drugs, and splenectomy in some cases. This review will cover general concepts about autoimmune hemolytic anemia, as well as laboratory diagnosis and treatments that can be performed.