Autoimmune hemolytic anemia: Difference between revisions
From IDWiki
(Imported from text file) |
(updated) |
||
Line 1: | Line 1: | ||
+ | ==Differential Diagnosis== |
||
− | == Etiologies == |
||
− | * |
+ | *Cold AIHA |
− | ** |
+ | **Primary: [[cold agglutinin disease]] (CAD) |
− | ** |
+ | **Secondary |
− | *** |
+ | ***Viral infections: [[EBV]], [[CMV]], others |
− | *** |
+ | ***Other infections: [[Mycoplasma]] (paroxysmal cold hemoglobinuria) |
− | *** |
+ | ***Other diseases: [[Waldenström macroglobulinema]], [[lymphoma]] |
− | *** |
+ | ***Drugs: [[lenalidomide]] |
− | * |
+ | *Warm AIHA |
− | ** |
+ | **Primary: warm AIHA |
− | ** |
+ | **Secondary |
− | *** |
+ | ***Viral infections: [[HIV]], vaccines |
− | *** |
+ | ***Other diseases: [[lupus]], [[CLL]] and other malignancies, chronic inflammatory disorders (including [[IBD]]) |
− | *** |
+ | ***Allogeneic [[hematopoietic stem cell transplantation]] |
− | *** |
+ | ***Drugs: [[cefotetan]], [[ceftriaxone]], [[piperacillin]], immune checkpoint-modulating drugs (e.g. [[nivolumab]]) |
− | * |
+ | *Drug-related |
− | ** |
+ | **[[Penicillin]] |
− | ** |
+ | **[[Methyldopa]] |
− | == |
+ | ==Management== |
− | === |
+ | ===Warm AIHA=== |
− | * |
+ | *Can be an emergency if severe and acute |
− | * |
+ | *If life-threatening, transfuse ABO-matched but incompatible blood, thereby sparing the patient's own cells |
− | * |
+ | *First-line: [[prednisone]] 1 mg/kg daily (response in 50% of patients) |
− | * |
+ | *Second-line: [[rituximab]] 100 mg/week for 4 weeks, with prednisone |
− | * |
+ | *Refractory: [[splenectomy]] |
− | === |
+ | ===Cold agglutinin disease=== |
− | * |
+ | *Chronic hemolysis in older patients caused by IgM antibodies produced by a B-lymphocyte clone (can show up as MGUS), therefore is essentially a form of [[Waldenström macroglobulinema]] |
− | * |
+ | *First-line: [[rituximab]] ± [[fludarabine]] |
− | * |
+ | *[[Prednisone]] and [[splenectomy]] are ''not'' helpful |
[[Category:Hematology]] |
[[Category:Hematology]] |
Latest revision as of 11:16, 29 July 2020
Differential Diagnosis
- Cold AIHA
- Primary: cold agglutinin disease (CAD)
- Secondary
- Viral infections: EBV, CMV, others
- Other infections: Mycoplasma (paroxysmal cold hemoglobinuria)
- Other diseases: Waldenström macroglobulinema, lymphoma
- Drugs: lenalidomide
- Warm AIHA
- Primary: warm AIHA
- Secondary
- Viral infections: HIV, vaccines
- Other diseases: lupus, CLL and other malignancies, chronic inflammatory disorders (including IBD)
- Allogeneic hematopoietic stem cell transplantation
- Drugs: cefotetan, ceftriaxone, piperacillin, immune checkpoint-modulating drugs (e.g. nivolumab)
- Drug-related
Management
Warm AIHA
- Can be an emergency if severe and acute
- If life-threatening, transfuse ABO-matched but incompatible blood, thereby sparing the patient's own cells
- First-line: prednisone 1 mg/kg daily (response in 50% of patients)
- Second-line: rituximab 100 mg/week for 4 weeks, with prednisone
- Refractory: splenectomy
Cold agglutinin disease
- Chronic hemolysis in older patients caused by IgM antibodies produced by a B-lymphocyte clone (can show up as MGUS), therefore is essentially a form of Waldenström macroglobulinema
- First-line: rituximab ± fludarabine
- Prednisone and splenectomy are not helpful