Gergal Gopalkrishna Rao Sanjay Rao
Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA.
Cureus. 2024 Jul 1;16(7):e63598. doi: 10.7759/cureus.63598. eCollection 2024 Jul.
Warm autoimmune hemolytic anemia (WAIHA) occurs due to antibodies active at body temperature that react with antigens on the surface of red blood cells, leading to hemolysis. Antibodies are typically IgG. WAIHA, associated exclusively with IgA antibodies, remains rare. Direct antiglobulin (Coombs) test may result negative in IgA antibody associated WAIHA. IgA-mediated WAIHA can present with severe hemolytic anemia. Further testing using an expanded direct antiglobulin test (DAT) panel is necessary to detect IgA antibodies if there is a high suspicion of autoimmune hemolytic anemia in cases that initially test negative for DAT. Steroids with or without rituximab are the mainstay of treatment. Early detection using an extended DAT panel with monospecific antisera helps avoid further investigations, unnecessary transfusions, and complications.
温抗体型自身免疫性溶血性贫血（WAIHA）是由于在体温下具有活性的抗体与红细胞表面的抗原发生反应，导致溶血。抗体通常为IgG。仅与IgA抗体相关的WAIHA仍然罕见。直接抗球蛋白（库姆斯）试验在IgA抗体相关的WAIHA中可能呈阴性。IgA介导的WAIHA可表现为严重的溶血性贫血。如果最初直接抗球蛋白试验（DAT）呈阴性，但高度怀疑自身免疫性溶血性贫血，则需要使用扩展的直接抗球蛋白试验（DAT）组合进行进一步检测以检测IgA抗体。使用或不使用利妥昔单抗的类固醇是主要治疗方法。使用含有单特异性抗血清的扩展DAT组合进行早期检测有助于避免进一步的检查、不必要的输血和并发症。
