1. Auto Immune hemolytic anemia
Nada Mohamed Ahmed ,
MD, MT (ASCP)i

2. Auto Immune hemolytic anemia
Nada Mohamed Ahmed ,
MD, MT (ASCP)i

3. HEMOLYTIC ANEMIA Hereditary Membrane defects PNH Intracorpuscular
WITHIN THE RED CELL
Extracorpuscular
OUTSIDE THE RED CELL
Hereditary
Acquired
AUTO-IMMUNE
1. Warm Ab
2. Cold Ab
3. Transfusion reactions
4. Drug associated
NON-IMMUNE
1. Hypersplenism
2. Infections (Malaria),,
3-mechanical trauma to RBCs
4. Liver dz (Spur cell)
1. Membrane defects
- Hereditary spherocytosis
- Hereditary elliptocytosis
- Hereditary pyropoikilocytosis
- Hereditary stomatocytosis
2. Enzyme defects
-G6PD
3. -Hemoglobin defects
-.Hemoglbinopathies(sickle cell disorders)
- Hb SS, CC, SC & S-B-
- Thalassemias
Membrane defects
PNH

4. Objectives Acquired hemolytic anemia
Immune mediated non.immune mediated
Cold warm infections physical agent

5. Nonimmune Hemolytic Anemia
These anemias represent a group of conditions that lead to the shortened survival of red cells by various mechanisms.
Causes
Antagonists
Hemolysis precipitated by either injury to the RBC membrane or to denaturation of Hb
Toxins, infectious agents
Physical trauma
Hemolysis caused by physical injury to RBC

6. Antagonists: Infectious Agents
Parasites: Intracellular infections
Malaria
Carried by mosquito
Release of the parasite from the cell causes cell lysis
Species of malaria include:
Plasmodium vivax
P. faciparum - most fatal
P. malariae - uncommon
P. ovale - uncommon
Peripheral smear examination will reveal intracellular parasites
Babesiosis
Tick-borne

7. Antagonists Venoms Burns
Some spiders contain enzymes that lyse the red cell membrane (i.e Brown Recluse). Snake venoms rarely cause lysis directly.
Burns
Burns over more than 15% of the body can cause hemolysis.
Anemia occurs within hours post-burn
It is thought that the direct effect of the heat on spectrin, causes the red cells to fragment and burst.

8. Physical Injury or Trauma
Intravascular and/or extravascular hemolysis
Striking abnormal shapes of the circulating blood, such as fragments and helmut cells

9. Autoimmune Hemolytic Anemia
Definition
Causes
Types
Antibody Characteristics
lab Diagnosis

10. Definition
It is defined as a group of hemolytic anemias that results from the development of auto-antibodies
They are directed against the antigen on the surface of the patient’s own cell

11. Etiology Breakdown of T-cell regulation for the B-cells
Change in the structure of the antigens on the red blood cells that recognized as non-self by the immune system

12. Etiology
3-It also depends on the efficiency of the destruction mechanism
4-The degree of anemia depends on the rate & acuteness of the destruction
5- Also on the capacity of the B.M to compensate

13. Antibody Characteristics
Can be catagorized by Direct comb’s test (DCT) & it’s thermal range:
Immunoglobulin class: detected by monospecific AHG against IgG, IgM, IgA & C3c & C3d using DAT
Warm-acting antibodies: are most active at 375C invitro
They are found to be polyclonal & predominantly IgG

14. Antibody Characteristics
It has Rh blood group complex specificity
In the serum Abs are detected using IAT
The percentage of detecting will rise to 90% in enzyme treated cells
They can also be eluted from the surface of red cells to determine their specificity

15. Antibody Characteristics
3. Cold acting antibodies
Predominantly are IgM most active at 45C to bind the antigen
Cold antibodies act as both agglutinins & lysins invitro with different thermal range.

16. Definition of Autoimmune Hemolytic Anemia
Result from RBC destruction due to RBC autoantibodies: Ig G, M, E, A
Most commonly-idiopathic
Classification
Warm AI hemolysis: Ab binds at 37degree Celsius
Cold AI Hemolysis: Ab binds at 4 degree Celsius

17. 1.Warm AutoImmune Hemolytic Anemia
Can occurs at all age groups
F > M
Causes:
50% Idiopathic
Rest - secondary causes:
1.Lymphoid neoplasm: CLL, Lymphoma, Myeloma
2.Solid Tumors: Lung, Colon, Kidney, Ovary, Thymoma
3. SLE, Systemic lupus erythematosus
4.Drugs: Alpha methyl DOPA, Penicillin , Quinine, Chloroquine

18. IMMUNOHEMOLYTIC ANEMIA
MACROCYTE
SPHEROCYTE
IMMUNOHEMOLYTIC ANEMIA

19. 1.WARM AIHA Lab Fingings Anemia, in which Hb varies with anemia
Reticulocytosis
Spherocytosis
+ve DCT (Direct comb’s test )
This is the typical blood picture
5. demonstrates microspherocyte, polychromatic macrocyte & few schistocytes

20. complement
Direct antiglobulin test demonstrating the presence of autoantibodies (shown here) or complement on the surface of the red blood cell.

21. 2. Cold AI Hemolysis Usually Ig M Acute or Chronic form Chronic:
Elderly patients
Cold , painful & often blue fingers, toes, ears, or nose ( Acrocyanosis)

22. Other causes of Cold Agglutination:
Cold AIHA
Other causes of Cold Agglutination:
Infection: Mycoplasma pneumonia,Mononucleosis
Mainly induced by IgM that causes intravascular hemolysis due to it’s ability to fix complement.

23. Cold AIHA lab Diagnosis - Autoagglutination ,shistocytes,
- Reticulocytosis ,numerous spherocyes,
-+ve DCT