Walker Marion, Ribordy Vincent, Waldvogel Abramowski Sophie
Service de médecine interne, HFR Fribourg - Hôpital cantonal, 1708 Fribourg.
Service des urgences, HFR Fribourg - Hôpital cantonal, 1708 Fribourg.
Rev Med Suisse. 2020 Nov 11;16(714):2183-2187.
Autoimmune hemolytic anemia is an uncommon disease that can be challenging to manage both for the emergency department physician and the general practitioner. The diagnosis is based on specific biological changes and on a positive direct Coombs test. Depending on the severity of the anemia and its clinical impact, an urgent blood transfusion can be required. However, ABO blood group typing and antibody screening may be impaired by autoantibodies. In case of vital need, a transfusion of ABO, Rh D and, if possible, C, c, E, e and Kell antigen matched red cells can be performed, before the complete achievement of the pre-transfusion testing. Further management includes the introduction of immunosuppression and the treatment of a possible underlying disease. Early contact with the hematologist, is strongly recommended.
自身免疫性溶血性贫血是一种罕见疾病，对急诊科医生和全科医生而言，其治疗都颇具挑战性。诊断基于特定的生物学变化以及直接抗人球蛋白试验阳性。根据贫血的严重程度及其临床影响，可能需要紧急输血。然而，自身抗体可能会干扰ABO血型鉴定和抗体筛查。在急需输血的情况下，可在完成输血前检测之前，输注ABO、Rh D以及尽可能匹配C、c、E、e和Kell抗原的红细胞。进一步的治疗包括采用免疫抑制疗法以及治疗可能存在的基础疾病。强烈建议尽早联系血液科医生。
