Ikezoe Takayuki
Department of Hematology, Fukushima Medical University.
Rinsho Ketsueki. 2025;66(7):565-571. doi: 10.11406/rinketsu.66.565.
Autoimmune hemolytic anemia (AIHA), which is caused by autoantibodies for red blood cell membrane antigens, is categorized into two forms: warm AIHA, which involves warm antibodies, and cold agglutinin disease (CAD), which involves hemolysis and red blood cell agglutination due to cold agglutinins. The first-line therapy for wAIHA is corticosteroids. Clinical guidelines by the British Society for Haematology recommend rituximab as second-line therapy, but Japanese national health insurance does not cover rituximab for wAIHA. Several new drugs with different mechanisms of action are in clinical development for refractory cases. Some of these drugs inhibit antibody production or promote antibody clearance, while others inhibit erythrophagocytosis. In CAD, anti-complement drugs targeting C1s improve anemia but do not treat peripheral circulatory failure due to erythrocyte aggregation. B-cell-targeted therapies should be used for patients with severe symptoms of these conditions.
自身免疫性溶血性贫血(AIHA)是由针对红细胞膜抗原的自身抗体引起的,分为两种形式:温抗体型自身免疫性溶血性贫血(warm AIHA),涉及温抗体;冷凝集素病(CAD),涉及由冷凝集素导致的溶血和红细胞凝集。温抗体型自身免疫性溶血性贫血的一线治疗是使用皮质类固醇。英国血液学学会的临床指南推荐利妥昔单抗作为二线治疗,但日本国民健康保险不涵盖温抗体型自身免疫性溶血性贫血使用利妥昔单抗的费用。几种具有不同作用机制的新药正在针对难治性病例进行临床开发。其中一些药物抑制抗体产生或促进抗体清除,而其他药物则抑制红细胞吞噬作用。在冷凝集素病中,针对C1s的抗补体药物可改善贫血,但不能治疗由于红细胞聚集导致的外周循环衰竭。对于这些病症症状严重的患者,应采用B细胞靶向疗法。