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Current Approaches for the Treatment of Autoimmune Hemolytic Anemia

Archivum Immunologiae et Therapiae Experimentalis volume 61, pages 385–395 (2013)Cite this article

Abstract

Autoimmune hemolytic anemia (AIHA) is an infrequent group of diseases defined by autoantibody mediated red blood cell destruction. Correct diagnosis and classification of this condition are essential to provide appropriate treatment. AIHA is divided into warm and cold types according to the characteristics of the autoantibody involved and by the presence of an underlying or associated disorder into primary and secondary AIHA. Due to its low frequency, treatment for AIHA is largely based on small prospective trials, case series, and empirical observations. This review describes in detail the different treatment approaches for autoimmune hemolytic anemia. Warm antibody type AIHA should be treated with steroids, to which most patients respond, although relapse can occur and maintenance doses are frequently required. Splenectomy is an effective second line treatment and can provide long-term remission without medication. Rituximab is a useful alternative for steroid refractory patients, those requiring high maintenance doses and unfavorable candidates for surgery. Promising therapeutic modifications with this monoclonal antibody are emerging including drug combinations, lower doses, and long-term use. Primary cold agglutinin disease has been recognized as having a lymphoproliferative monoclonal origin. It is unresponsive to both steroids and splenectomy. Rituximab is currently the best therapeutic alternative for this condition, and several treatment regimens are available with variable responses.

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  1. Internal Medicine Division, Department of Hematology, “Dr. José Eleuterio González” University Hospital of the School of Medicine of the Universidad Autónoma de Nuevo León, Monterrey, Mexico

    José Carlos Jaime-Pérez, Marisol Rodríguez-Martínez, Andrés Gómez-de-León, Luz Tarín-Arzaga & David Gómez-Almaguer

  2. Servicio de Hematología, Edificio “Dr. Rodrigo Barragán”, 2 piso, Hospital Universitario “Dr. José E. González” Avenida Madero y Gonzalitos S/N, Colonia Mitras Centro, CP 64460, Monterrey, Nuevo León, Mexico

    José Carlos Jaime-Pérez

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  1. José Carlos Jaime-Pérez
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Jaime-Pérez, J.C., Rodríguez-Martínez, M., Gómez-de-León, A. et al. Current Approaches for the Treatment of Autoimmune Hemolytic Anemia. Arch. Immunol. Ther. Exp. 61, 385–395 (2013). https://doi.org/10.1007/s00005-013-0232-3

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Keywords

  • Hemolytic anemia
  • Autoimmune
  • Cold agglutinin disease
  • Treatment
  • Rituximab